COMPARATIVE ANALYSIS OF CATHETER AND SURGICAL ABLATION OF ATRIAL FIBRILLATION AFTER FAILED ENDOCARDIAL PULMONARY VEIN ISOLATION

To compare effectiveness and safety of catheter and surgical radiofrequency ablation (RFA) for treatment of patients with paroxysmal and persistent atrial fibrillation (AF) after failed primary endocardial pulmonary vein isolation (PVI), 64 patients were examined and treated. In the course of surgical RFA, radiofrequency application was initially made in the area of pulmonary vein ganglionic plexuses followed by passing around pulmonary veins using a dissector, with their subsequent isolation with the aid of bipolar clamp. The final step consisted in creation of two ablation lines from the right upper and lower pulmonary veins on the left atrial dome and inferior wall reaching the left pulmonary veins. In the radiofrequency catheter ablation subjects, access to the left atrium and pulmonary veins was achieved through the inter-atrial septum. Absence of electrical activity inside isolated pulmonary veins was the endpoint of circular PVI. In all patients with persistent AF, PVI was accompanied by creation of inter-collector line on the left atrium roof, as well as the mitral isthmus ablation. The Reveal XT device was implanted subcutaneously in the left parasternal area. After 12 months of follow-up, 26 of 32 (81%) patients in the surgical RFA group were free of paroxysms AF/atrial flutter/atrial tachycardia, as opposed to 15 of 32 patients (47%) in the catheter RFA. The subjects of both groups did not take antiarrhythmics. Thus, the “video assistant” surgical RFA is more effective than catheter RFA. The incidence of serious adverse events was higher in the surgical RFA group as compared with the catheter RFA group during treatment of patients with paroxysmal and persistent AF after the failed primary endocardial PVI.

atrial fibrillation, left atrium, pulmonary veins, radiofrequency catheter ablation, surgical ablation, thoracoscopy, atrial flutter, loop recorder

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