Improved Outcome Following Restoration of Sinus Rhythm Prior to Catheter Ablation of Persistent Atrial Fibrillation: A Comparative Multicenter Study

Jul 26, 2012
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Authors:
Rivard L, Hocini M, Rostock T, et al.
Citation:
Heart Rhythm 2012;9:1025-1030.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does ≥1 month of sinus rhythm (SR) before radiofrequency catheter ablation (RFCA) of persistent atrial fibrillation (AF) improve outcomes?

Methods:

Forty patients (SR group, mean age 59 years) with persistent AF underwent RFCA after cardioversion that resulted in SR for ≥1 month before ablation. Forty control patients matched for age, gender, and AF duration were identified retrospectively from among contemporary patients. Approximately 45% of patients in both groups were taking amiodarone at the time of RFCA. In the SR group, AF was induced by rapid pacing. A stepwise ablation strategy was employed in both groups, the endpoint being AF termination by ablation. The patients were followed for 1 year with serial 48-hour Holter monitors. There was a 3-month blanking period. Success was defined as freedom from AF/atrial flutter >30 seconds in duration after one procedure.

Results:

AF termination by ablation occurred significantly more often in the SR group (95%) than in the control group (78%). AF converted directly to SR much more frequently in the SR group (82% vs. 12%). The mean total amount of radiofrequency energy delivered was significantly shorter in the SR group (48 minutes) than in the control group (97 minutes), as was the mean procedure time (200 vs. 284 minutes). The success rate did not differ significantly between the SR group (55%) and the control group (45%).

Conclusions:

Restoration of SR before RFCA of persistent AF facilitates ablation without compromising efficacy.

Perspective:

The results of this interesting study suggest that 1 month of SR is sufficient to allow for reverse remodeling, and that this facilitates termination of persistent AF by ablation.

Keywords: Electric Countershock, Atrial Fibrillation, Electrocardiography, Electrophysiologic Techniques, Cardiac, Heart Rate, Catheter Ablation, Atrial Flutter


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