Effectiveness comparison of various atrial fibrillation ablation methods in patients with common venous trunk.

BACKGROUND: Atrial fibrillation (AF) is a common clinical problem. The left atrium anatomy makes up a factor that may significantly affect the effectiveness of the AF ablation.

OBJECTIVES: The aim of the study was to evaluate a long-term effectiveness ablation in patients with common pulmonary vein trunk (CPVT) and AF.

MATERIAL AND METHODS: The outcomes of 129 procedures in 95 patients with CPVT out of 1,475 procedures carried out in 1,150 patients with AF treated with ablation, were analyzed. Ablation with CARTO 3 system (Johnson & Johnson, New Brunswick, USA), cryoballoon, and the circular multipolar duty-cycled radiofrequency-based pulmonary vein ablation producer with catheter (PVAC) were considered as advanced methods. The following data was recorded for every patient: age, gender, AF duration and type, previous antiarrhythmic drugs, weight, height, any prior cardioversion, and comorbidities, including hypertension, diabetes, hypothyreosis, thyrotoxicosis, heart failure, and stroke/transient ischemic attack. The following anatomical factors were assessed: the presence of patent foramen ovale (PFO) and localization of the CPVT on the basis of venography or computed tomography (CT). In the 1st year after ablation, 24-h Holter monitoring was performed 3-5 times, and the patients were encouraged to visit their doctor or an emergency department if a cardiac arrhythmia occurred. Long-term ablation effectiveness was assessed based on a telephone interview and patients' answers to the questionnaires including 12-lead electrocardiography (ECG).

RESULTS: Sinus rhythm was maintained in 44 patients (43.6 %) after a median of 42 months (range 12-120). A lower number of clinical factors (odds ratio [OR] range 0.09; 95% confidence interval [CI] 0.02-0.56; p < 0.01), and advanced ablation methods (OR 3.1; 95% CI 1.4-7.1; p < 0.01) were related to a better longterm effectiveness.

CONCLUSIONS: The long-term effectiveness of pulmonary vein (PV) isolation in patients with AF and CPVT is higher when advanced ablation techniques are used. Accumulation of clinical factors was found to be the most tremendous predictor of AF recurrence.