Safety, Efficacy and Learning Curve of Catheter Ablation of Paroxysmal Atrial Fibrillation Using Circumferential Pulmonary Vein Isolation Technique in the Single Center and in a Single Operator
|School||Dalian Medical University|
|Keywords||Atrial fibrillation Radiofrequency catheter ablation Circumferentialpulmonary vein isolation Recurrence risk factors Learning curve|
Objective: CARTO anatomical mapping system and circumferential pulmonaryvein isolation (CPVI) technique has been used to cure paroxysmal atrial fibrillation(PAF) in most hospitals in China, and have achieved a high success rate. But whetherthe successful rate, the recurrence rate and the safety are related to learning cure is stillunclear. In this study the efficacy and the safety were analyzed and compared betweendifferent periods in the single center and in a single operator using the same CPVIapproach for ablation of PAF.Methods: From December2004to December2010,258consecutive patients whounderwent circumferential pulmonary vein isolation (CPVI) for PAF in our hospitalwere collected. The patients were divided into three groups with equal patient numbersaccording to the time sequences. Group I consisted of the first86cases, Group Ⅱconsisted of the second86patients，and Group Ⅲ consisted of the last86cases. Age,gender, course of disease, echocardiography [including left atrium diameter (LAD), leftventricular end-diastolic inner diameter (LVEDD), left ventricular ejection fraction(LVEF)], other atrial arrhythmias (such as atrial flutter, atrial tachycardia, atrialpremature complexes), basic diseases (including hypertension, diabetes, coronary heartdisease, cerebral infarction, hyperthyroidism, rheumatic heart disease, congenital heartdisease, cardiomyopathy) were analyzed statistically. The operation X-ray exposuretime, recent recurrence, late recurrence and re-ablation procedures were also analyzed.In addition, the learning curve of CPVI for PAF and its relationship with peri-operativeperiod complications (such as cardiac tamponade, cerebral thrombus/thromboembolism, ecchymoma, esophagus atrial fistula, pulmonary vein stenosis), and the risk factors topredict the recurrence of atrial arrhythmias were analyzed, too.Results: There were no significant differences in patients’ age, gender, basicdiseases and LAD among three groups. The rates of early recurrence in Group I, GroupⅡ and Group Ⅲ were38/86(44.2%),26/86(30.2%) and21/86(24.4%) respectively(P<0.05). The successful rates at1year were44.2%,51.2%,64.0%respectively(P<0.05) in three groups. The incidence of general complications was12.8%in Group I[including pericardial tamponade in4cases (4.7%), cerebral thrombosis in3cases(3.5%) and ecchymoma in4cases (4.7%)],4.7%in Group Ⅱ [including pericardialtamponade in1cases (1.2%), ecchymoma in3cases (3.5%)], and2.3%in group Ⅲ[(including ecchymoma in2cases (2.3%)]. There were statistically significantdifferences between the total complication rates among the three groups. In manyvariables, left atrium dimension (LAD) enlargement and early recurrence were the riskfactors of recurrent AF (P<0.01and P<0.05，respectively).Conclusion: For an experienced operator, CPVI has a higher success rate, a lowerrecurrence and a lower complication rate for radiofrequency catheter ablation of PAF.However, for a beginning operator, the success rate was relatively lower, both therecurrence and the complication rate were higher, and the X-ray exposure time waslonger. The strengthened training of CPVI technique for PAF may be very important forthe new operator to increase the success and to avoid or decrease the incidence ofcomplications.