Radiofrequency atrial fibrillation ablation based on pathophysiology: a diversified protocol with long-term follow-up

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Abstract
The optimal approach and long-term results of radiofrequency catheter ablation of atrial fibrillation (AF) are still unknown. We report our experience with respect to an ablation protocol diversified on a patient's AF pathophysiology with long-term follow-up. Seventy-two patients with paroxysmal/persistent drug-resistant AF were selected. Patients with apparently normal hearts (group 1, n = 20) underwent electrophysiological disconnection of pulmonary veins (PVs) presenting a clear PV potential, whereas those with even initial cardiopathy (group 2, n = 52), underwent PV encircling. Sinus rhythm was maintained at 6 months in 85% of group 1 and 71% of group 2 patients. After 42 months of follow-up, including 15.2% re-do procedures, 85% of group 1 and 77% of group 2 patients were in sinus rhythm, including patients with anti-arrhythmic drugs (AADs). The long-term success rate without AADs was 75% and 46% for each group, respectively. Age and the 6-month success of the procedure were predictive of sinus rhythm maintenance during follow-up. An ablation protocol diversified on AF pathophysiology assured, at 3 years of follow-up, sinus rhythm maintenance in 85% of patients with a normal heart and in 77% of those with even initial cardiopathy. The 6-month result of the ablation procedure remained stable over time.