Percutaneous Catheter Ablation in comparison with Minimal Invasive Pulmonary Vein Isolation in the treatment of drug-resistant Atrial Fibrillation

Schreuder, L.M. (2016) Percutaneous Catheter Ablation in comparison with Minimal Invasive Pulmonary Vein Isolation in the treatment of drug-resistant Atrial Fibrillation. thesis, Medicine.

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Abstract

Introduction: The cornerstone of invasive AF treatment is pulmonary vein isolation (PVI). Both minimally invasive thoracoscopic epicardial PVI (MIPI) and percutaneously performed endocardial PVI (catheter ablation) are accepted treatments. As no randomized data is present for patients undergoing a first ablation, it is yet unclear which approach is most effective. Methods: We conducted a randomized controlled trial in patients without structural heart disease, with paroxysmal or persistent AF, undergoing a first ablation. Patients were randomized to MIPI with left atrial appendage (LAA) excision or percutaneous catheter ablation (CA). Radiofrequency energy was used for all ablations. All patients were monitored with implantable continuous loop monitors from 6 months before ablation up to 2 years after. The primary outcome measure was freedom of atrial tachyarrhythmia. Results were analyzed on an ‘intention-to-treat’ basis. The safety endpoint was freedom of complications, and was analyzed on an ‘as treated’ basis. Results: Between 2007 and 2013, 50 patients with drug-refractory AF were randomized to CA (n=25) or MIPI (n=25). Median age was 57 years (range 37-75), 78% were male and 74% had paroxysmal AF. All patients had 2 years of follow-up. After 2 years, more patients were free of atrial tachyarrhythmia after CA versus MIPI (12/27, 44% versus 6/22 27%, P=0.047). More procedure related major complications occurred in the MIPI-group (0% after CA and 22% after MIPI, p=0.016). Conclusion: Percutaneous PVI results in lower long-term AF recurrence rates than surgical PVI with LAA excision. Furthermore, less procedure related complications occur after percutaneous PVI than after surgical PVI.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor and Adiyaman, Dr. A. and Department Cardiology and Location Isala clinics, Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:45
Last Modified:	25 Jun 2020 10:45
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/639

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