Catheter ablation of atrial fibrillation guided by a 3D electroanatomical mapping system: a 2-year follow-up study from the Italian Registry On NavX Atrial Fibrillation ablation procedures (IRON-AF)

Aims Clinical trials have established that atrial fibrillation (AF) catheter ablation improves symptoms in appropriately selected patients. Confirmation of these results by long-term prospective observational studies is needed. This registry was created to describe the experience of 16 Italian cente...

Full description

Saved in:
Bibliographic Details
Published in:Journal of interventional cardiac electrophysiology 2013-06, Vol.37 (1), p.87-95
Main Authors: Forleo, Giovanni B., De Martino, Giuseppe, Mantica, Massimo, Menardi, Endrj, Trevisi, Nicola, Faustino, Massimiliano, Muto, Carmine, Perna, Francesco, Santamaria, Matteo, Pandozi, Claudio, Pappalardo, Augusto, Mancusi, Carmine, Romano, Enrico, Della Bella, Paolo, Tondo, Claudio
Format: Article
Language:English
Subjects:
Atrial Fibrillation - diagnosis
Atrial Fibrillation - mortality
Atrial Fibrillation - surgery
Body Surface Potential Mapping - methods
Body Surface Potential Mapping - statistics & numerical data
Cardiology
Catheter Ablation - methods
Catheter Ablation - mortality
Female
Follow-Up Studies
Humans
Imaging, Three-Dimensional - methods
Imaging, Three-Dimensional - statistics & numerical data
Italy - epidemiology
Male
Medicine
Medicine & Public Health
Middle Aged
Prevalence
Registries
Risk Factors
Surgery, Computer-Assisted - methods
Surgery, Computer-Assisted - mortality
Survival Rate
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Aims Clinical trials have established that atrial fibrillation (AF) catheter ablation improves symptoms in appropriately selected patients. Confirmation of these results by long-term prospective observational studies is needed. This registry was created to describe the experience of 16 Italian centers with a large cohort of AF patients treated with catheter ablation guided by the NavX 3D mapping system. Methods From November 2006 to May 2008, 545 consecutive patients (age 60.4 ± 9.8, 67 % male) with paroxysmal (44 %), persistent (43 %), and long-standing persistent (13 %) AF referred for catheter ablation guided by the NavX system, were included in this registry. For this paper, follow-up was censored at 24 months; however, patients are being followed in the ongoing registry. Results Before the ablation, 80 % of patients failed to respond to at least one antiarrhythmic drug aimed at rhythm control. Pulmonary vein (PV) isolation guided by a circular mapping catheter was performed in 70 % of patients whereas non potential-guided PV encircling was performed in 30 % of patients. In 67 % of patients, additional left atrial (LA) substrate modification was performed. Image integration was performed in 9.2 % of patients. Considering a 3-month blanking period, after a single-ablation procedure, the patients had 1- and 2-year freedom from AF recurrence of 67.4 and 57.0 % (36.1 % off antiarrhythmic drugs), respectively. Cox regression analysis showed that AF recurrences during blanking (HR 2.1), and previous AF ablation (HR 3.3) were independent predictors of AF recurrences. Major procedure-related complications occurred in 53 patients (9.7 %). In 35 patients (6.7 %), a repeat procedure was performed at a median of 5 months after the initial procedure. Conclusions This prospective, multicenter clinical experience provides significant insights into current ablation care of patients with AF. Despite favorable outcomes, real-world complication rates appear higher than previously recognized.
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-012-9772-4