Tay Julian Cheong Kiat, Cai Xinzhe James, Lin Jing, Liang Shufen, Him Ai Ling, Hamid Sherida Binte Syed, Wong Kelvin Cheok Keng, Yeo Colin, Tan Vern Hsen
Department of Cardiology, Changi General Hospital (CGH), Singapore.
National Heart Center Singapore (NHCS), Singapore.
Int J Cardiol Heart Vasc. 2020 Oct 23;31:100661. doi: 10.1016/j.ijcha.2020.100661. eCollection 2020 Dec.
Catheter ablation is increasingly being performed worldwide for atrial fibrillation (AF). However, there are concerns of lower success rates and higher complications of AF ablations performed in low-volume centers. Thus, we sought to evaluate the safety and efficacy of AF catheter ablation in a low-volume center using contemporary technologies.
71 consecutive patients (50 paroxysmal AF [pAF] vs 21 persistent AF) who underwent first catheter ablation were studied. Primary outcome was AF recurrence rate. Secondary outcomes included periprocedural complications, hospitalization for symptomatic tachy-arrhythmias post-ablation and number of repeat ablations. Mean age of our cohort was 59.1 ± 9.7 years, of which 56 (78.9%) were males. 1-year AF recurrence was 19.5% in pAF and 23.8% in persistent AF (p = 0.694). Ablation in persistent AF group required longer procedural (197.76 ± 48.60 min [pAF] vs 238.67 ± 70.50 min [persistent AF], p = 0.006) and ablation duration (35.08 ± 15.84 min [pAF] vs 52.65 ± 28.46 min [persistent AF], p = 0.001). There were no significant differences in secondary outcomes. Major periprocedural complication rate was 2.8%.Subset analysis on (i) cryoablation vs radiofrequency, (ii) Ensite vs CARTO navigational system and (iii) circular vs high density mapping catheter did not yield significant differences in primary or secondary outcomes.
The AF ablation complication and recurrence free rates in both paroxysmal and persistent AF at one year were comparable to high-volume centers. Long-term follow up is needed. In addition, first AF catheter ablation in a low-volume center is realistic with comparable efficacy and safety outcomes to high-volume centers using contemporary ablation technologies.
在全球范围内，导管消融治疗心房颤动（AF）的应用日益广泛。然而，人们担心在低手术量中心进行的AF消融成功率较低且并发症较多。因此，我们试图使用当代技术评估低手术量中心AF导管消融的安全性和有效性。
对71例连续接受首次导管消融的患者（50例阵发性AF [pAF] 与21例持续性AF）进行了研究。主要结局是AF复发率。次要结局包括围手术期并发症、消融术后有症状快速性心律失常的住院情况以及重复消融次数。我们队列的平均年龄为59.1±9.7岁，其中56例（78.9%）为男性。pAF患者1年AF复发率为19.5%，持续性AF患者为23.8%（p = 0.694）。持续性AF组的消融手术时间（197.76±48.60分钟 [pAF] 与238.67±70.50分钟 [持续性AF]，p = 0.006）和消融持续时间（35.08±15.84分钟 [pAF] 与52.65±28.46分钟 [持续性AF]，p = 0.001）更长。次要结局无显著差异。主要围手术期并发症发生率为2.8%。对（i）冷冻消融与射频消融、（ii）Ensite与CARTO导航系统以及（iii）环状与高密度标测导管的亚组分析在主要或次要结局方面未产生显著差异。
阵发性和持续性AF患者1年的AF消融并发症和无复发率与高手术量中心相当。需要进行长期随访。此外，在低手术量中心进行首次AF导管消融是可行的，其疗效和安全性结局与使用当代消融技术的高手术量中心相当。
