AUTHOR=You Ling , Zhang Xiaohong , Yang Jing , Wang Lianxia , Zhang Yan , Xie Ruiqin 

TITLE=The Long-Term Results of Three Catheter Ablation Methods in Patients With Paroxysmal Atrial Fibrillation: A 4-Year Follow-Up Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.719452

DOI=10.3389/fcvm.2021.719452

ISSN=2297-055X

ABSTRACT=Aims: Catheter ablation of paroxysmal atrial fibrillation (PAF) has been shown to be effective and safe. However, recurrence of PAF varies between 10% and 30% for radiofrequency ablation. There have been no reports comparing long-term recurrence rates following radiofrequency ablation, cryoablation, and three-dimensional guided cryoablation plus radiofrequency ablation. The aim of this study was to observe the long-term recurrence rate of PAF when treated by the three catheter ablation methods, and to explore clinical factors that can potentially predict PAF recurrence after catheter ablation.

Methods: 238 patients were involved in this study, including 106 radiofrequency (RF) ablation cases (RF group), 66 cryoablation cases (Freeze group) and 66 cases treated by three-dimensional guided cryoablation combined with radiofrequency ablation (Freeze-plus-RF group). All patients underwent standardized follow-up. The recurrence rate of atrial fibrillation (AF) in the three groups was calculated. Predictive factors for the recurrence of AF were also investigated.

Results: At 48 months (the median follow-up period), the sinus rhythm maintenance rate was 77.4% in the RF group, 72.7% in the Freeze group, and 81.8% in the Freeze-plus-RF group. The maintenance rate of sinus rhythm was highest in the Freeze-plus-RF group, but differences among the three groups were not statistically significant. Further analysis found that the preoperative left atrial appendage emptying velocity (LAAEV) (recurrence vs no recurrence, 56.58±18.37 vs 65.59±18.83, respectively, p=0.003 ), left atrial (LA) anteroposterior dimension (recurrence vs no recurrence, 36.56±4.65 vs 35.00±4.37, respectively; p=0.028) and LA vertical dimension (recurrence vs no recurrence, 56.31±6.96 vs 53.72±6.52, respectively; p=0.035) were related to postoperative recurrence. Multiple Cox regression analysis showed that only LAAEV was predictive of postoperative recurrence of PAF (hazard ratio: 0.979; 95% confidence interval: 0.961-0.997).

Conclusion: Our study found that there was no statistically significant difference in long-term recurrence rates among the RF, Freeze and Freeze-plus-RF groups. Preoperative LAAEV is an independent predictor of postoperative recurrence of PAF.