[Outcomes of catheter ablation of atrial fibrillation in patients over 65 years of age]. / Výsledky katetrové ablace fibrilace síní u pacientu nad 65 let.

PURPOSE: This study assessed ablation techniques, recurrent arrhythmias, long-term outcomes, and complications of catheter ablation for atrial fibrillation (AF) in patients 65 years of age. METHODS: Consecutive patients aged < 65 years (n = 653) vs 65 years (n = 213), who underwent catheter ablation of AF in the course of eight years, were compared. Ablation strategy and procedure endpoints were left at the operators discretion. RESULTS: The group of patients 65 years comprised more females (p < 0.001), and more frequently presented with persistent AF (p = 0.010). These patients less frequently underwent simple pulmonary vein isolation (p = 0.017); on the contrary, extensive ablation including coronary sinus intervention was more common (p = 0.020). There was no difference in repeat ablation procedures (25 % vs 26 % patients; p = 0.823, or 1.4 vs 1.5 ablation procedures/1 patients; p = 0.479, respectively). Spectrum of recurrent arrhythmias did not differ between the groups except for more frequent paroxysmal AF before the first repeat ablation in patients < 65 years (p = 0.050). At the end of 49 ± 26 month total follow-up, stable sinus rhythm (SR) was achieved in 85 % patients < 65 years vs 76 % patients 65 years (p = 0.318). To maintain stable SR, older patients more often continued to take antiarrhythmic medication (p = 0.054). More serious complication occurred in 3.8 % of the patients 65 years vs 2.1 % of the patients < 65 years of age (p = 0.207). CONCLUSION: Patients 65 years of age achieved insignificantly worse long-term outcome after insignificantly fewer repeat ablation procedures, and with more frequent use of antiarrhythmic drugs. SR maintenance and risk of complications were, however, favorable.

[Catheter ablation of atrio-ventricular accessory pathways in the era of ablation therapy of complex arrhythmias: a changing perspective for oncoming generation of electrophysiologists]. / Katetrová ablace atrioventrikulárních prídatných drah v ére ablacní lécby komplexních arytmií: menící se perspektiva pro nastupující generaci elektrofyziologu

INTRODUCTION: Catheter ablation of atrio-ventricular accessory pathways has become a routine treatment method. However, its perspective has been changing in the era of ablation of complex arrhythmias. This study was aimed at evaluating accessory pathways ablation efficacy within the last nine years at one center. METHODS: From February 2002 to June 2011, catheter ablation of accessory pathways was performed in 247 patients (100 females, 42 ± 16 years). Elimination of accessory pathways conduction in both directions was the procedure endpoint. RESULTS: Immediate accessory pathways conduction elimination at the first ablation was achieved in 228 (92%) patients. Ablation failed to eliminate accessory pathways conduction in 19 (8%) patients, or accessory pathways conduction subsequently recurred in another 7 (3%) patients. Repeat ablation was completed in 20 (8%) patients, 2 patients underwent a third ablation procedure. In total, accessory pathway was permanently eliminated in 238 (96%) patients. Ablation failure was connected with a risky position in the vicinity of atrio-ventricular conduction system in 6 (67 %) out of 9 patients. By the individual A, B, C, D operators experience, efficacy of the first procedure/total efficacy, was 97%/99%, 90%/96%, 87%/87%, and 91%/91%, respectively (comparison of inter-operator efficacy of the first and repeat ablation by Kruskal-Wallis ANOVA test: p = 0,19 and 0,05, respectively). CONCLUSION: Accessory pathways ablation efficacy exceeds 95%, and ablation failure is dominantly related to the accessory pathways location close to the atrio-ventricular conduction system. Individual operator's experience was associated with a certain disparity between high and nearly absolute accessory pathways ablation efficacy.

Characterization of residual coronary sinus-related tachycardia during ablation of longstanding persistent atrial fibrillation.

PURPOSE: The aim was to characterize the coronary sinus (CS)-related tachycardia that occurred as the last residual arrhythmia and required ablation within the CS or great cardiac vein to restore sinus rhythm (SR) in patients with primary longstanding persistent AF. METHODS: The study included 23 patients in whom stable SR was restored by ablation inside the vein during the first or repeat ablation. RESULTS: The 23 subjects represented 23% of the 99 patients in whom SR was restored by ablation. A reentry tachycardia confined to the CS musculature was suggested in 8 (35%) patients, and a peri-mitral reentry circuit was present in 14 (61%) patients. Twenty (87%) patients have remained free from arrhythmia and class I or III antiarrhythmic drugs for 33 +/- 10 (12-53) months. CONCLUSION: A majority of the residual CS-related tachycardias exhibit properties of reentry, one third utilizing the CS musculature as a reentry substrate independent of the atrial myocardium.

[Catheter ablation of chronic atrial fibrillation using circumferential and complex linear lesions in the left atrium: modes of arrhythmia termination and long-term clinical outcome]. / Katetrová ablace pro chronickou fibrilaci síní metodou obkruzujících a komplexních lineárních lézí v levé srdecní síni. Ukoncení arytmie pri ablaci a dlouhodobé klinické výsledky.

OBJECTIVE: The aim of the article is to present the method and results of catheter ablation for chronic atrial fibrillation. METHOD: Catheter ablation for chronic atrial fibrillation was performed in 82 patients (18 females, aged 54 +/- 10 years), in 112 ablation procedures. Mean duration of the chronic phase of atrial fibrillation was 28 +/- 28 months. Before ablation, amiodarone was administered without effect to 74 (90%) patients, and was counter-indicated in 8 (10%) patients. Ablation strategy consisted of circumferential lesions around the pulmonary veins and of complex linear lesions in the left atrium. Full pulmonary vein antra isolation, and sinus rhythm restoration, or at least converting atrial fibrillation into the left atrial tachycardia, were the procedure end points. RESULTS: Sinus rhythm was restored by ablation at least in one of the ablation procedures in 43 (52%) patients. During the follow-up period spanning 17.3 +/- 11.6 months after the last ablation, stable sinus rhythm was achieved in 63 (77%) patients, of whom 38 (60%) had their sinus rhythm restored by ablation and another 14 (22%) their atrial fibrillation converted into the left atrial tachycardia. Of the 63 patients with stable sinus rhythm, class I or III antiarrhythmic medication has been maintained in 21 (33%) patients, and amiodarone has been taken by 13 (21%) patients. CONCLUSION: Catheter ablation of chronic atrial fibrillation is potentially highly effective in long-term restoration of sinus rhythm.

[Recurrent arrhythmias after catheter ablation of originally paroxysmal atrial fibrillation and results of repeat ablation]. / Recidivující arytmie po katetrové ablaci puvodne paroxyzmální fibrilace síní a výsledky opakované ablace.

AIMS: The aim is a description of the recurrent arrhythmias after previous ablation of paroxysmal atrial fibrillation (AF), and the results of a repeat catheter ablation. METHODS: A repeat ablation was performed in 76 patients (18 females, 54 +/- 11 years) in 96 procedures, which was 21% out of 362 patients, who had undergone the first ablation for a paroxysmal AF. The endpoints of the repeat ablation were re-isolation of the pulmonary veins (PV) and termination of a spontaneous or induced arrhythmia and restoration of a stable sinus rhythm (SR), and possibly achievement of noninducibility of any arrhythmia. RESULTS: Clinical left atrial tachycardia (LAT) was present in 10 (13%) patients before the first, and in 5 (25%) patients before the second repeat ablation. Arrhythmia arising from an arrhythmogenic PV due to the conduction recovery into the left atrium (LA) was found in 50 (66%) patients during the first, and in 7 (35%) patients during the second repeat ablation. Arrhythmias, predominantly of the reentry mechanism and originating in the LA free wall, were found in 26 (34%), respectively 13 (65%) during the first or the second repeat ablation. All arrhythmias from PVs were terminated by a PV encircling ablation. Substrate-related arrhythmias were terminated by ablation except for 2 (3%) patients during the first and 3 (15%) patients during the second repeat ablation. Persistent AF was mainly terminated via conversion into a LAT. In these cases, the ablation sites leading to the SR restoration were, similarly to the primary LATs, located predominantly in the LA anterior wall. During the 22 +/- 13 months follow-up, 68 (89%) patients were free of AF, 54 (71%) patients off the antiarrhythmic drugs and 14 (18%) patients with the class I or III antiarrhythmic drugs. CONCLUSION: AF associated with PV-LA re-connection dominated prior to the first repeat ablation, then the proportion of the substrate-related arrhythmias from the LA free wall increased. Clinical efficacy of the repeat ablation is high.