SPC365

Single-Shot compared to Point-by-Point Atrial Fibrillation Ablation Success

Session: CO 13- Atrial fibrilation
Speaker: Rita Rocha

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Caldeira Da Rocha; Rita Carvalho; Mafalda Carrington; Afonso Ferreira; Maria Brito; Gustavo Silva; Nuno Cortez Dias; Luís Carpinteiro; Fausto Pinto; João de Sousa

<p>Introduction:&nbsp;Pulmonary vein electrical isolation&nbsp;is the cornerstone in atrial&nbsp;fibrillation (AF) ablation.&nbsp;The two widely used approaches are&nbsp;point-by-point&nbsp;radiofrequency application or&nbsp;single-shot&nbsp;therapy.&nbsp;&nbsp;Catheter AF ablation is effective in restoring and maintaining sinus rhythm. However,&nbsp;efficacy is&nbsp;limited by&nbsp;a&nbsp;high rate of AF recurrence, after&nbsp;an&nbsp;initially successful procedure.&nbsp;</p>

<p>Purpose:&nbsp;To evaluate AF&nbsp;initial&nbsp;ablation&nbsp;successfulness&nbsp;using single-shot techniques and compare&nbsp;them&nbsp;to&nbsp;the conventional procedure&nbsp;(point-by-point&nbsp;using&nbsp;irrigated-&nbsp;tip&nbsp;ablation&nbsp;catheter).&nbsp;</p>

<p>Methods:&nbsp;We&nbsp;analyzed, from a single center,&nbsp;all patients submitted to an index&nbsp;AF ablation procedure and&nbsp;its&nbsp;successfulness. The last was defined as&nbsp;AF,&nbsp;atrial&nbsp;tachycardia&nbsp;or flutter&nbsp;recurrence (with a duration superior to 30&nbsp;seconds) event-free survival, determined by&nbsp;Holter&nbsp;and/or&nbsp;event&nbsp;recorder. These exams were&nbsp;performed at&nbsp;6 and 12months and then&nbsp;annually,&nbsp;until 5&nbsp;years&nbsp;after the procedure.&nbsp;</p>

<p>Results:&nbsp;From November 2004 to November 2020, 821patients were submitted&nbsp;to&nbsp;a&nbsp;first AF ablation (male patients&nbsp;67.2%&nbsp;(N=552), mean age of 59&plusmn;12years old).&nbsp;Paroxysmal AF&nbsp;(PAF)&nbsp;was present in 62.9%&nbsp;(N=516),&nbsp;short-duration&nbsp;persistent&nbsp;AF&nbsp;in 21.8%&nbsp;(N=179) and&nbsp;long-standing persistent in 15.3%&nbsp;(N=126). Ablation techniques were irrigated tip catheter point-by-point&nbsp;(PbP)&nbsp;ablation in 266 patients&nbsp;(32,4%) and single-shot&nbsp;(SS)&nbsp;techniques in&nbsp;the remaining 555(67,6%), including PVAC in 294&nbsp;(35,8%),&nbsp;balloon&nbsp;cryo-ablation&nbsp;in 225(27,4%)&nbsp;and&nbsp;nMARQ&nbsp;in 36(4,4%).&nbsp;Globally,&nbsp;AF ablation had&nbsp;a one-year success rate of 72.5%,&nbsp;and 56.2% at 3 years. A significant difference between AF&nbsp;type was found:&nbsp;arrhythmic recurrence risk was 58% higher in persistent AF&nbsp;(PeAF)&nbsp;(HR 1.58;95%IC 1,22-2,04;&nbsp;p&lt;0.001).&nbsp;In patients presenting with&nbsp;PAF, success was significantly higher in those submitted to&nbsp;SS&nbsp;technique&nbsp;(HR:0.69;95%CI 0,47-0,90;p=0.046), while&nbsp;those with&nbsp;PeAF&nbsp;had similar results.&nbsp;</p>

<p>Conclusion:&nbsp;In this&nbsp;single center analysis almost three-quarters&nbsp;of AF patients&nbsp;had achieved&nbsp;one-year event-free survival, and more than a half reached&nbsp;long-term freedom from atrial arrhythmia. Patients with paroxysmal atrial fibrillation submitted to single-shot procedure had&nbsp;a higher success-rate.&nbsp;Moreover, our study confirmed previous data&nbsp;regarding a lower success rate in&nbsp;PeAF&nbsp;linking AF&nbsp;classification to the ablation outcome.</p>

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