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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
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28. Risk Factors and Prevention
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
35. Research Methodology
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The impact of manual vs remote magnetic navigation in the very long-term outcomes of catheter ablation of atrial fibrillation – a propensity score analysis
Session:
Posters 5 - Écran 06 - Arritmologia Invasiva
Speaker:
João Pedro Vilaça Delgado de Almeida e Mesquita
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
João Mesquita; António Ferreira; Diogo Cavaco; Francisco Moscoso Costa; Pedro Lopes Do Carmo; Francisco Bello Morgado; Miguel Mendes; Pedro Adragão
Abstract
<h3><strong>Background:</strong> </h3> <p>Long-term outcomes of AF ablation guided by a remote magnetic navigation system (MNS) remain unclear.</p> <h3><br /> <strong>Objective:</strong> </h3> <p>To compare the safety and very long-term efficacy of a single pulmonary vein isolation (PVI) procedure using MNS vs conventional manual navigation.</p> <h3><br /> <strong>Methods:</strong> </h3> <p>Consecutive patients with drug-refractory AF who underwent a first PVI (2006-2008) were included in a multicenter observational registry (n=253 (age 55 years (IQR 48-63), 80% males, 64% paroxysmal AF)). Study endpoint was recurrence of AF/atrial tachyarrhythmia after a 3-month blanking period. To estimate the treatment effect of the type of navigation, a propensity score (PS) model was developed using this characteristic as the dependent variable and relevant baseline characteristics as covariates. PS probabilities in the treatment group (MNS) were matched in a 1:2 fashion to the nearest control patient (manual navigation).</p> <h3><br /> <strong>Results:</strong> </h3> <p>MNS guided ablation in 81 (32%) patients, who were matched with 111 controls (Fig A). 54 (49%) control patients relapsed vs 46 (57%) in the MNS (P=0.307) - annual relapse rates of 8%/year vs 10%/year, respectively (P=0.242) (Fig B). MNS was associated with longer radiofrequency application (52 (IQR 40-69) vs 27 (IQR 18-43) min (P<0.001)) and procedure duration (194 (165-238) vs 144 (115-175) min (P<0.001)) but reduced fluoroscopy time (8 (IQR 6-11) vs 19 (IQR 14-25) min (P<0.001)). Major complications were rare (<1.8%) and similar between both groups.</p> <h3><br /> <strong>Conclusion:</strong> </h3> <p>Manual and MNS were equally safe and effective in preventing very long-term AF relapse after ablation. MNS is associated with longer procedures and radiofrequency application duration but less radiation exposure</p>
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