Clinical efficacy and safety of CARTO-guided ablation for the elderly with atrial fibrillation: analysis of 50 cases
  
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DOI:10.3724/SP.J.1264.2014.00104
Key words:elderly  atrial fibrillation  radiofrenquency catheter ablation  treatment outcome  safety  recurrence
Author NameAffiliationE-mail
YANG Xi-Xi, CUI Ying-Kai, MA Yong-Na, XIE Ya-Nan, CAO Xue-Bin* Department of Cardiology, Diagnostic and Treatment Center of Geriatric Cardiovascular Diseases, Chinese PLA Hospital No.252, Baoding 071000, China caoxb252@163.com 
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Abstract:
      Objective To analyze the efficacy and safety of the procedures dominated by circumferential pulmonary vein ablation and combined with other catheter ablation approaches, guided by CARTO system in the treatment of the elderly atrial fibrillation (AF), and also to analyze the risk factors for recurrence. Methods A total of 50 elderly AF patients admitted in our department from July 2009 to July 2011 were recruited in this study. There were 37 males and 13 females, with age ranging from 60 to 76 (66.78±4.09) years. There were 43 cases of paroxysmal AF, 5 cases of persistent AF, and 2 cases of permanent AF (<2 years). A procedure dominated by circumferential pulmonary vein ablation and supplemented by other ablation strategies was applied under the guidance of CARTO system, and the primary endpoint of ablation was complete isolation of pulmonary vein. After a continuous follow-up for 12 months after the surgery, the surgical success rate, recurrence rate, recurrence-related factors and the incidence of complications were analyzed. Results The success rate of 50 patients achieved 100% immediately after the surgery, and the rate reduced to 80% in postoperative follow-up of 1 year after ablation. One case (2%) suffered from cardiac tamponade, which was relieved by cardiac catheterization. Two cases (4%) had pericardial effusion without tamponade symptoms, 1 (2%) had bilateral exudative pleural effusion, and 2 (4%) experienced hematoma at the puncture site. In 6 months after the radiofrequency ablation, 40 patients maintained sinus rhythm successfully (success group) and got left atrial diameter (LAD) reduced in size at various extents by cardiac ultrasound examination. However, no significant change in LAD was observed in the 10 patients who failed to maintain sinus rhythm (recurrence group). The mean difference of LAD before and after treatment was (4.64±1.12)mm in success group and (0.40±0.61)mm in recurrence group (P<0.01). The left ventricular ejection fraction in the both groups remained no significant change before and after surgeries. In 12 months after surgery, 10 cases (20%) suffered recurrence in total, and 2 of them (4%) were permanent AF, 3 (6%) of persistent AF, and 5 (10%) of paroxysmal AF. The elderly persistent AF, permanent AF and preoperative LAD were risk factors for recurrence after radiofrequency catheter ablation. Conclusion CARTO-guided radiofrequency catheter ablation is safe and efficient in the treatment of the elderly AF.
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