Comparison of catheter ablation and surgical ablation in patients with long-standing persistent atrial fibrillation and rheumatic heart disease: A four-year follow-up study

• Published in: International journal of cardiology 2013-10, Vol.168 (6), p.5372-5377
• Main Authors: Gu, Jun, Liu, Xu, Jiang, Wei-feng, Li, Feng, Zhao, Liang, Zhou, Li, Wang, Yuan-long, Liu, Yu-gang, Zhang, Xiao-dong, Wu, Shao-hui, Xu, Kai, Zhang, Dao-liang, Gu, Jia-ning
• Format: Article
• Language: English
• Subjects: Adult; Aged; Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Electrophysiology; Cardiac Surgical Procedures; Cardiology. Vascular system; Cardiovascular; Catheter Ablation; Diseases of the osteoarticular system; Female; Follow-Up Studies; Heart; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Prospective Studies; Pulmonary Veins - surgery; Recurrence; Rheumatic heart disease; Rheumatic Heart Disease - physiopathology; Rheumatic Heart Disease - surgery; SICTRA; Sternotomy; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2013.08.057

Abstract Background In our previous prospective and randomized study, we have demonstrated that the concomitant surgical ablation using saline-irrigated cooled tip radiofrequency ablation (SICTRA) system is more effective than subsequent circumferential pulmonary vein isolation (CPVI) combined with substrate modification in treating patients with long-standing persistent atrial fibrillation (LS-AF) and rheumatic heart disease (RHD) undergoing cardiac surgery during middle-term follow-up. Whether this strategy also decreases longer-term arrhythmia recurrence is unknown. This study describes the 4-year efficacy of SICTRA for these patients. Furthermore, we seek to compare the electrophysiological characteristics for recurrent atrial tachyarrhythmia (ATa) at the session of catheter ablation between two groups. Methods Long-term follow-up was performed in 95 patients who underwent the catheter ablation strategy (n = 47, Group A) or SICTRA (n = 48, Group B) combined with valvular surgery for symptomatic LS-AF patients with RHD. Results After one procedure, Group B had a significantly higher freedom from ATa compared with Group A (29/48 vs 15/47, P = 0.005) after a mean follow-up of 54 months (range 48 to 63 months). Catheter-based mapping and ablation of recurrent ATa showed larger amounts of macro-reentrant atrial tachycardias (ATs) in Group B and higher incidence of pulmonary vein (PV) recovery in Group A. After multiple catheter ablations for recurrent ATa, sinus rhythm (SR) could be maintained equally between two groups. Conclusions Single procedure success seems to be higher with SICTRA but repeated catheter ablation potentially results in comparable outcomes in treating patients with LS-AF and RHD during long-term follow-up. More macro-reentrant ATs and more PV recoveries are identified to be responsible for ATa in SICTRA and catheter ablation group, respectively.