Email this article LONG-TERM EFFICACY AND HEALTH STATUS IN PATIENTS WITH ATRIAL FIBRILLATION AFTER RADIOFREQUENCY ENDOCARDIAL CATHETER ABLATION IN MAZE REGIMEN
- Authors: Protasov M.E.1, Batalov R.E.2, Khlynin M.S.2, Protasova E.A.3, Kisteneva I.V.2, Popov S.V.2
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Affiliations:
- Republican Cardiology Dispensary
- Research Institute for Сardiology
- Research Institute of Cardiology, Saratov State Medical University named after V.I. Razumovsky
- Issue: No 38 (2015)
- Pages: 50-57
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/268
- DOI: https://doi.org/10.18786/2072-0505-2015-38-50-57
- ID: 268
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Abstract
Aim: To evaluate efficacy of endocardial radiofrequency catheter ablation (RFA) in atrial fibrillation (AF) in Maze regimen, to assess patients’ health status with a European Quality of Life Questionnaire (EQ-5D) and cardiovascular mortality in patients after the intervention taking anticoagulants.
Materials and methods: 391 patients with AF (247 of them males) aged from 18 to 77 years (mean age 54.9 ± 10.1 years) were examined and got treatment. All patients underwent RFA, including pulmonary vein isolation, linear ablations of the posterior wall, left atrial roof and mitral isthmus. Their health status was assessed according to efficacy of the intervention and data from EQ-5D questionnaires.
Results: At 3 and 36 months after the intervention, RFA efficacy in patients with paroxysmal AF was 92% and 83.3%, respectively, and in patients with persistent AF, 89.7% and 72.4%. According to EQ-5D “thermometer”, after 36 months patients with successful catheter ablation assessed their health status as being approximately at the same level as during initial hospitalization, i.e., in patients with paroxysmal AF this scale scored at 79.74% and 81.4%, and in patients with persistent AF, at 79.94% and 81.06%, respectively. However, if the endocardial Maze procedure was unsuccessful, there was a deterioration of health status from 80.8% to 70.14% in patients with paroxysmal AF and from 77.82% to 69.46% in those with persistent AF. The same trend was observed in the analysis of other EQ-5D items. All-cause cardiovascular mortality in the subgroup with successful RFA was lower than in the subgroup with unsuccessful RFA, irrespective of AF form (p < 0.001). A 36-month mortality rate in patients with paroxysmal AF after a successful RFA was 2.1% and in patients with persistent AF, 1.2%, after unsuccessful RFA the corresponding values being 13.4% and 9.6%. Causes of death in patients with successful and unsuccessful RFA were different. After successful RFA for paroxysmal AF, the main cause of death was myocardial infarction (80%), and only 1 patient (20%) died of hemorrhagic stroke. The main cause of death after unsuccessful ablation in paroxysmal AF was ischemic stroke (83%), and only 1 patient (17%) died of myocardial infarction. In patients with persistent AF and successful RFA, there was only 1 death at 24 months after the intervention due to acute myocardial infarction. In the subgroup with unsuccessful RFA, the single cause of death in all patients who died was ischemic stroke.
Conclusion: Maze RFA showed high efficacy in patients with paroxysmal and persistent AF, being somewhat lower in those with persistent AF. Maintenance of sinus rhythm in addition to medical treatment allows for a substantial reduction of cardiovascular mortality compared to anticoagulation only within the rate control strategy.
About the authors
M. E. Protasov
Republican Cardiology Dispensary
Author for correspondence.
Email: meprotasov@yandex.ru
Cardiovascular Surgeon, Department of Surgical Treatment of Complex Heart Arrythmias and Electrical Cardiac Stimulation
РоссияR. E. Batalov
Research Institute for Сardiology
Email: fake@neicon.ru
PhD, Senior Research Fellow, Department of Surgical Treatment of Complex Heart Arrythmias and Electrical Cardiac Stimulation
РоссияM. S. Khlynin
Research Institute for Сardiology
Email: fake@neicon.ru
PhD, Junior Research Fellow, Department of Surgical Treatment of Complex Heart Arrythmias and Electrical Cardiac Stimulation
РоссияE. A. Protasova
Research Institute of Cardiology, Saratov State Medical University named after V.I. Razumovsky
Email: fake@neicon.ru
Junior Research Fellow, Laboratory of Emergency Cardiology
РоссияI. V. Kisteneva
Research Institute for Сardiology
Email: fake@neicon.ru
PhD, Research Fellow, Department of Surgical Treatment of Complex Heart Arrythmias and Electrical Cardiac Stimulation
РоссияS. V. Popov
Research Institute for Сardiology
Email: fake@neicon.ru
MD, PhD, Professor, Correspondent Member of the Russian Academy of Sciences, Head of Department of Surgical Treatment of Complex Heart Arrythmias and Electrical Cardiac Stimulation
РоссияReferences
- Артеменко СН, Романов АБ, Туров АН, Шабанов ВВ, Елесин ДА, Якубов АА, Стрельников АГ, Камиев РТ, Лосик ДВ, Покушалов ЕА. Сравнительная оценка радиочастотной остиальной, антральной изоляции устьев легочных вен и аблации ганглионарных сплетений у пациентов с фибрилляцией предсердий. Вестник аритмологии. 2012;(68):14–20. Artemenko SN, Romanov AB, Turov AN, Shabanov VV, Elesin DA, Yakubov AA, Strel'nikov AG, Kamiev RT, Losik DV, Pokushalov EA. Sravnitel'naya otsenka radiochastotnoy ostial'noy, antral'noy izolyatsii ust'ev legochnykh ven i ablatsii ganglionarnykh spleteniy u patsientov s fibrillyatsiey predserdiy [Сomparison of outcomes of ostial and antral pulmonary vein isolation and ganglionated plexus ablation in patients with atrial fibrillation]. Vestnik aritmologii [Journal of arrythmology]. 2012;(68):14–20 (in Russian).
- Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5.
- Stewart S, Hart CL, Hole DJ, McMurray JJ. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart. 2001;86(5):516–21.
- Баталов РЕ, Попов СВ, Егай ЮВ. Лечение фибрилляции предсердий (обзор литературы). Сибирский медицинский журнал. 2011;26(4):8–14. Batalov RE, Popov SV, Egay YuV. Lechenie fibrillyatsii predserdiy (obzor literatury) [Treatment of atrial fibrillation (review)]. Sibirskiy meditsinskiy zhurnal [Siberian Medical Journal]. 2011;26(4):8–14 (in Russian).
- Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, Stijnen T, Lip GY, Witteman JC. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27(8):949–53.
- Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, Seward JB,Tsang TS. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation.
- ;114(2):119–25.
- Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104(11):1534–9.
- Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98(10):946–52.
- Герок ДВ, Кейко ОИ, Гиляров МЮ, Седов ВП, Новикова НА. Сократимость предсердий и антикоагулянтная терапия у больных с фибрилляцией предсердий после электрической кардиоверсии. Вестник аритмологии. 2011;(66):46–9. Gerok DV, Keyko OI, Gilyarov MYu, Sedov VP, Novikova NA. Sokratimost' predserdiy i antikoagulyantnaya terapiya u bol'nykh s fibrillyatsiey predserdiy posle elektricheskoy kardioversii [Atrial contractility and anticoagulant therapy in patients with atrial fibrillation after electric cardioversion]. Vestnik aritmologii [Journal of arrythmology]. 2011;(66):46–9 (in Russian).
- Ревишвили АШ, Рзаев ФГ, Сопов ОВ, Лабазанова АЛ. Отдаленные результаты интервенционного лечения фибрилляции предсердий. Вестник аритмологии. 2012;(68):5–13. Revishvili ASh, Rzaev FG, Sopov OV, Labazanova AL. Otdalennye rezul'taty interventsionnogo lecheniya fibrillyatsii predserdiy [Long-term results of interventions for atrial fibrillation].
- Vestnik aritmologii [Journal of arrythmology]. 2012;(68):5–13 (in Russian).
- Баталов РЕ, Роговская ЮВ, Рябов ВВ, Татарский РБ, Сазонова СИ, Хлынин МС, Попов СВ, Карпов РС. Идиопатическая форма фибрилляции предсердий, воспаление и клинические результаты радиочастотной аблации. Российский кардиологический журнал. 2014;(12):7–12. Batalov RE, Rogovskaya YuV, Ryabov VV, Tatarskiy RB, Sazonova SI, Khlynin MS, Popov SV, Karpov RS. Idiopaticheskaya forma fibrillyatsii predserdiy, vospalenie i klinicheskie rezul'taty radiochastotnoy ablatsii [Idiopathic form of atrial fibrillation, inflammation and clinical results of radiofrequency ablation]. Rossiyskiy kardiologicheskiy zhurnal [Russ J Cardiol]. 2014;(12):7–12 (in Russian).
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