Patients should be encouraged to document any symptoms on ECGs. Each visit should include an ECG, and a 1 to 7 days Holter monitoring is recommended at three to six months intervals for one to two years of follow-up (Figure 1). Practical monitoring recommendations: follow-up of patients should be done monthly for at least three months, and then ideally every six months for at least two years.A new ablation procedure is indicated depending on clinical worsening despite antiarrhythmic drugs therapy. O Very late recurrences: recurrences occurring after 12 months of follow-up occur in 5% to 10% of patients, and they are commonly due to PVs reconnection. In these cases our efforts should be focused on restoring sinus rhythm, using electrical cardioversion or controlling ventricular rate. When these tachycardias have a fast ventricular rate, patients can suffer a symptomatic worsening. Regular atrial tachycardias are usually due to re-entrant arrhythmias using conduction gaps that cross ablation lines. In many cases they are self-limited during the initial three to six months of follow-up. Atrial tachycardias can be observed in 5-25% of patients after catheter AF ablation, representing at least 10% of the recurrences. These early recurrences are probably due to the inflammatory reaction created by multiple RF applications. O Early recurrences: 45% of patients present AF recurrence during the first three months of follow-up, however, more than a half will not have any further arrhythmias during long-term follow-up. Obviously, the longer the period monitored, the greater the likelihood of detecting recurrences. Various types of monitoring systems can be used to detect recurrences. Main limitation: the main limitation is that many recurrences are asymptomatic.Clinical success: although for research purposes the definition of recurrence, as well as the time to recurrence of AF are eligible endpoints, it may under-represent the true benefit of ablation, because in many cases there is a significant arrhythmic burden reduction and an evident improvement of symptoms and quality of life.There is a general consensus that a blanking period of 3 months should be considered when reporting outcomes and before considering a repeated ablation procedure. In about 45% of the cases this recurrence occurs during the initial 3 months after the procedure despite antiarrhythmic drug treatment, and more than 60% of patients will not present further recurrences during long-term follow-up. Definition: in a strict sense, any episode of AF/flutter/tachycardia lasting 30 seconds at least should be considered as a recurrence.However, reviewing the outcome on persistent AF ablation, success rate of the initial procedure does not reach 50%. Arrhythmic recurrences following AF catheter ablationĪnalysis of the results reported in many prospective single centre studies, shows that the single procedure efficacy on paroxysmal AF ablation ranges from 38 to 78%, and it usually exceeds 70% when considering multiple procedures. The Worldwide survey on methods, efficacy and safety of catheter ablation of AF, published in 2005, reported a success rate (defined as freedom from symptomatic AF in the absence of antiarrhythmic therapy) of 52%, with 6% major complications. Differences in technical proficiency, and so forth.Differences in the employment of antiarrhythmic drugs.Differences in techniques, follow-up, or definitions of success.Epidemiological variables such as age, concomitant cardiac disease, LA size, and comorbidity, such hypertension or severe obstructive sleep apnoea disease.The type of AF (paroxysmal, persistent or longstanding persistent AF).When we review published literature regarding outcomes of AF catheter ablation, we must be conscious of the potential factors that may impact outcome, including: Thereby in those cases in which we expect a great benefit (as in highly symptomatic patients with congestive heart failure and/or depressed ejection fraction or a high rate of success (as those with short episodes of paroxysmal AF, without structural heart disease, and normal left atrium size AF ablation is recommended as first line therapy (table 1). Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia, and in the last decade, catheter ablation has evolved from a nearly experimental and uncertain procedure, to a routine and well established one in many major hospitals around the world.ĭespite this fact, symptomatic AF refractory or intolerant to antiarrhythmic medication is the only accepted indication for AF ablation (Class IIb with a level of evidence C), in daily clinical practice the indications have rapidly expanded.
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