SPC365

Catheter Ablation as a Treatment for Atrial Fibrillation: Experience and Results from a High Volume Portuguese Tertiary Center

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: Pedro Ribeiro Queirós

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Posters
FP Number: ---
Authors: Pedro Ribeiro Queirós; Gualter Silva; Mariana Ribeiro Da Silva; João Almeida; Paulo Fonseca; Diogo Ferreira; Fábio Sousa Nunes; Mariana Brandão; Rafael Teixeira; Marco Oliveira; Helena Gonçalves; Nuno Dias Ferreira; João Primo; Ricardo Fontes-Carvalho

<p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Background/Introduction:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> Catheter ablation (CA) is established as a treatment option to reduce disease burden in atrial fibrillation (AF) patients, especially those refractory to antiarrhythmic drugs (AAD). However, data describing the experience and results with this technique is still lacking. </span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">To describe the characteristics, complications and outcomes of AF patients treated with CA for AF at our centre. </span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> Patients undergoing CA for AF at our center between January 2017 and October 2019 were retrospectively analysed. </span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">A total of 444 patients were included. Average follow up time was 2.3&plusmn;1.0 years. Mean age was 56.4&plusmn;11.7 years. Sixty-five percent of patients were male (n=290). Mean body mass index was 27.4&plusmn;4.0 kg/m</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">, and mean CHA</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">DS</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">-VASc score was 1.44&plusmn;1.3. Heart failure was present in 8.6% of patients (n=38) and 11.5% had moderate/severe mitral disease (n=51); mean indexed left atrial volume was 38.3&plusmn;12.6 mL/m</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">. Average time since the diagnosis of AF was 3.6&plusmn;3.4 years, and 80.6% had paroxysmal AF (n=358), with 21.5% having also typical or atypical atrial flutter (n=50). AAD were prescribed in 57.6% of patients at the time of ablation, and 37.9% had done at least one electrical cardioversion previously (n=139). Only 6.8% of patients were undergoing a redo procedure (n=30), all of whom had at least one pulmonary vein reconnected. Radiofrequency (RF) and cryoballoon (CB) were the techniques utilised for ablation, with RF used more commonly (70.0% vs. 30.0%); when atrial mapping was done, low voltage areas were found in 9.1% (n=31). The procedure lasted 110&plusmn;24 minutes on average, with the RF ones lasting longer (118.5&plusmn;21.2 vs. 90.9&plusmn;19.6 minutes; p &lt;0.001) but resulting in lower fluoroscopy time (10.2&plusmn;5.9 vs. 80.4&plusmn;21.4 minutes; p &lt;0.001) and radiation doses (141.8&plusmn;109.8 vs. 266.6&plusmn;157.0 uGy; p &lt;0.001). Isolation of all pulmonary veins was achieved in 94.4% (n=418). Complications were reported in 4.5% of procedures (n=20); local haematoma was the most common (1.5%, n=7), and severe complications (major bleeding, cardiac tamponade, myocardial infarction, stroke/TIA or, atrio-esophageal fistula) were rare (1.1%, n=5). AF was detected during the blanking period in 12.8% (n=57), and this translated to AF recurrence in 78.9% (n=45). Overall recurrence rate was 28.2% (n=125), most commonly as paroxysmal AF (75.2%, n=94); however, average time to recurrence was 2.0&plusmn;1.1 years and symptoms were absent in 29.6% (n=37). A redo procedure was needed in 9.4% (n=42). Major adverse events (cardiovascular death, emergency room visits for AF, hospital admission for AF, stroke/TIA) were reported in 11.4% (n=51), mostly due to visits to emergency room visits for AF (90.2%, n=46). </span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">In our cohort, CA&nbsp; was successfully used to treat AF, resulting in significant time free from AF and apparently decreasing AF burden with a low complication rate.</span></span></span></p>