Vol 22, No 3 (2015)
Original articles
Published online: 2015-06-19

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Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation

Mihran Martirosyan, Alexandra Kiss, Edina Nagy-Baló, Gábor Sándorfi, Diana Tint, István Édes, Zoltán Csanádi
DOI: 10.5603/CJ.a2014.0085
Pubmed: 25428730
Cardiol J 2015;22(3):260-265.

Abstract

Background: Although atrial fibrillation (AF) ablation is considered a technically challenging procedure, studies on the learning curve of different pulmonary vein isolation (PVI) techniques are limited. We investigated the time-dependent changes in procedural parameters, complication rates, and in the 1-year clinical outcome during our initial experience with circular multipolar phased radiofrequency (RF) ablation.

Methods and results: The first 132 consecutive patients (40 female; age: 56.6 ± 10.4 years) who underwent PVI with phased RF ablation for paroxysmal or persistent AF at our center were included in the study. Procedural parameters and atrial arrhythmia-free survival were compared in the first, second and third group of 44 successive patients. All pulmonary veins were successfully isolated in 44 (100%), 41 (93.8%) and 42 (95.5%) patients in Tierce 1, 2 and 3, respectively (p = 0.233). The number of RF applications (per vein) required for isolation and fluoroscopy times demonstrated a significant decrease with experience, and a trend towards lower procedure times in Tierces 2 and 3 was also observed. Atrial arrhythmia-free survival rates at 12 months postablation were 68.18%, 75%, and 70.75% in Tierce 1, Tierce 2 and Tierce 3, respectively (p = 0.772). Pericardial tamponade requiring percutaneous subxi­phoid drainage occurred in 1 patient (Tierce 3) as the only significant procedural complication.

Conclusions: A learning curve effect was demonstrated in fluoroscopy times and in the number of RF applications but not in the acute success and in the long-term arrhythmia-free survival with circular multipolar RF ablations.