[Radiofrequency catheter ablation of atrial fibrillation performed under general anesthesia: results of a unicentric randomized trial]. / Radiofrekvencní katétrová ablace pro fibrilaci síní provádená v celkové anestezii: výsledky unicentrické randomizované studie.

INTRODUCTION: Radiofrequency catheter ablation (RFA) has recently become a routine part of atrial fibrillation (AF) treatment. The goal of our study was to determine whether the implementation of RFA of AF under general anesthesia (GA), compared to analgosedation (AS), will affect important characteristics of the ablation procedure, comfort of the patient and whether there is any clinical impact on the complication rate and the overall success of the procedure. METHODS: 50 patients with AF were randomized in a ratio of 1 : 1 into two groups for RFA in AS and in GA. Procedural characteristics, arrhythmia-free survival for the time of 12 months and subjective evaluation of pain tolerability of the procedure were monitored. RESULTS: Overall procedural times were comparable in GA and AS groups (111.2 ± 16.3 min vs 104.8 ± 25 min, p = NS). Time needed for preparation of patients was significantly longer in the GA group, while time needed for electrical disconnection of all pulmonary veins (PVs) was significantly shortened. Electrical isolation of the ipsilateral PVs after the last RF application was achieved in 94 % of lesions in GA and in 78 % of lesions in AS, respectively (p = 0.02). Shorter time of RF energy application to achieve electrical isolation of PVs was needed in the group of GA than in the group of AS (1 386 ± 387 s vs 1 745 ± 463 s, p = 0.005). Subjective discomfort evaluation of the procedure was more favorable in patients in the GA group. 88 % of patients in the GA group vs 68 % patients in AS (p = 0.1) had stable sinus rhythm off antiarrhythmic treatment during the 12 month period following the index procedure. While in the GA group all 3 patients with AF recurrence were willing to undergo another procedure in the GA, in the AS group only one patient out of 8 patients with AF recurrences underwent reablation. CONCLUSION: RFA of AF performed under GA provided improved tolerance and positive perception of the procedure, higher final treatment success and improved quality of life.Key words: general anesthesia - paroxysmal atrial fibrillation - pulmonary vein isolation - radiofrequency catheter ablation.

Incidence, treatment strategies and outcomes of acute coronary syndrome with and without ongoing myocardial ischaemia: results from the CZECH-3 registry.

BACKGROUND: Patients with acute coronary syndrome with signs of ongoing myocardial ischaemia at first medical contact should be indicated for immediate invasive treatment. AIM: To assess the incidence, treatment strategies and outcomes of acute coronary syndrome in a large unselected cohort of patients with respect to the signs of ongoing myocardial ischaemia. METHODS: The CZECH-3 registry included 1754 consecutive patients admitted for suspected acute coronary syndrome to 43 hospitals during a 2-month period in the autumn of 2015. Acute coronary syndrome with ongoing myocardial ischaemia was defined by the presence of persistent/recurrent chest pain/dyspnoea and at least one of the following: persistent ST-segment elevation or depression, bundle branch block, haemodynamic or electric instability due to suspected ischaemia. Major adverse cardiac events (death, reinfarction, stroke, unexpected revascularisation, stent thrombosis) and severe bleeding according to Bleeding Academic Research Consortium criteria were evaluated at 30 days. RESULTS: Acute coronary syndrome was ruled out during the hospital stay in 434 (24.7%) patients. Out of 1280 patients with confirmed acute coronary syndrome, 732 (57%) had clinical signs of ongoing myocardial ischaemia at first medical contact. Coronary angiography was performed in 94.7% of patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 89% of patients with confirmed acute coronary syndrome without ongoing myocardial ischaemia (P<0.001). The major adverse cardiac event rate was 9.8% for patients with confirmed acute coronary syndrome with ongoing myocardial ischaemia and 5.5% for patients without ongoing myocardial ischaemia (P=0.005), the 30-day severe bleeding rate was 1.6% and 1.5% (P=1.0). Patients with ongoing myocardial ischaemia admitted to regional hospitals had higher major adverse cardiac event rates compared with patients admitted directly to cardiocentres with percutaneous coronary intervention capability (13.3% vs. 8.2%, P=0.034). CONCLUSIONS: Ongoing myocardial ischaemia was present in more than half of patients hospitalised with acute coronary syndrome. These very high-risk patients may benefit from direct admission to percutaneous coronary intervention-capable centres.