Primerjava učinkovitosti zdravljenja s konvergentnim posegom in katetrsko ablacijo pri bolnikih s paroksizmalno atrijsko fibrilacijo

Jan, Matevž (author), Geršak, Borut (mentor), Žižek, David (co-mentor)

Uvod Katetrska ablacija (CA) z izolacijo pljučnih ven je uveljavljena metoda zdravljenja bolnikov s paroksizmalno atrijsko fibrilacijo (AF), konvergentna epikardialna in endokardialna ablacija (CVP) pa je namenjena predvsem zdravljenju bolnikov s perzistentno obliko AF. Cilj naše randomizirane študije je bila primerjava učinkovitosti in varnosti zdravljenja obeh metod pri bolnikih s paroksizmalno AF. Za sledenje pojavnosti aritmije (AF, atrijske tahikardije (AT) in atrijske undulacije (AFL)) smo uporabili vsadni monitor ritma (ILR). Metode in rezultati Randomizirali smo petdeset bolnikov (74 % moških) z znano paroksizmalno AF, pri katerih smo opravili CVP ali CA. Uspešnost posega smo ovrednotili s pomočjo ILR. Vsako 6 minutno zabeleženo epizodo AF/AT/AFL smo definirali kot ponovitev aritmije. Analizo pojavnosti, bremena AF, ponovitve posega in kardioverzije smo opravili po 3 mesečni slepi dobi. Trajanje posega (266±44 in 242±39 minut) in ablacij (52±10 in 48±12 minut) je bilo podobno v obeh skupinah. Ponovitev AF/AT/AFL je bila bolj verjetna v CA kot v CVP skupini (OR 3.78 (95 % CI (1.17, 12.19), p = 0.048)). Med sledenjem (30.5±6.9 mesecev), smo v CA skupini zabeležili višje breme AF in več ponovnih posegov zaradi ponovitve aritmije. V CVP skupini je bilo več zapletov kot pri skupini, kjer smo opravili CA (12.5 in 0 %). Zaključki Po zdravljenju s CVP so imeli bolniki s paroksizmalno AF, v primerjavi z zdravljenjem s CA, manj ponovitev aritmije. Imeli so tudi nižje breme AF in manj ponovnih posegov, vendar več zapletov.

• Language: Slovenian
• Keywords: paroksizmalna atrijska fibrilacija, konvergentni poseg, katetrska ablacija, vsadni monitor ritma
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2024
• PID: 20.500.12556/RUL-155290
• Publication date in RUL: 24.03.2024

Secondary language

• Language: English
• Title: Comparison of treatment outcomes with convergent procedure and catheter ablation in patients with paroxysmal atrial fibrillation

Abstract

Introduction While catheter ablation (CA) is an established treatment for symptomatic paroxysmal atrial fibrillation (AF), convergent epicardial and endocardial ablation procedure (CVP) has been primarily used to treat persistent AF. The aim of this randomized study was to compare treatment efficacy of CA and CVP in paroxysmal AF patients by monitoring AF, atrial tachycardia (AT) and atrial flutter (AFL) recurrence with Implantable Loop Recorder (ILR). Methods and results Fifty patients (74 % male) with history of paroxysmal AF were randomized between CA and CVP. Outcomes were determined by ILRs; every episode of AF/AT/AFL lasting 6 minutes or more was defined as a recurrence. AF burden (AFB) and required AF re-interventions (cardio-versions and repeat ablations) were quantified after a 3-month blanking period. Total procedural (266±44 vs 242±39 minutes) and ablation duration (52±10 vs 48±12 minutes) was similar in both groups. Recurrence of AF/AT/AFL was more likely in the CA group compared to the CVP group (OR 3.78 (95 % CI (1.17, 12.19), p = 0.048)). During the follow-up period (mean 30.5±6.9 months), higher AF burden and more re-interventions for recurrent AF were recorded in the CA group. There were more peri-procedural complications in the CVP group (12.5 %) compared to the CA group (0 %). Conclusions Treatment of paroxysmal AF with CVP showed less arrhythmia recurrence compared to CA. In addition, patients after CVP had fewer re-interventions and lower AF burden, but more periprocedural complications.

• Keywords: paroxysmal atrial fibrillation, convergent procedure, catheter ablation, implantable rhythm monitor