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How to improve outcomes from ablation

Professor Mark O’Neill, Guys and St Thomas’ Hospital, London, reviewed the evidence for the use of contact force (CF) information to optimise AF ablation. To ensure adequate ablation lesion delivery, an adequate catheter-tissue contact is needed with the creation of durable, transmural scar necessary to prevent AF recurrence. The ability of ablation catheters to provide CF information in real time provides obvious benefits – better control over lesion size and reduction in ineffective radiofrequency energy delivery. Interestingly, the SMART-AF trial did not demonstrate increased clinical effectiveness with higher average CF but did suggest that if operators were able to achieve an optimal CF, then clinical outcomes were improved.

Dr Mark Earley (Bart’s Health NHS Trust, London) reviewed the clinical predictors of outcome in patients with longstanding-persistent AF (AF >1 year in duration). In univariate analyses from previous studies, factors that predicted outcome included: duration of AF (>2 years associated with worse outcome); extent of left atrial (LA) fibrosis, LA volume, obesity, hypertension, presence of structural heart disease and extent of endocardial scar. In multivariate analyses most of these factors did not reach statistical significance as they are mostly interrelated.

Dr Tim Betts (Oxford University Hospitals NHS Trust) addressed the need to individualise strategies to treat patients with AF. The use of pre-procedure imaging (MRI) to assess pulmonary vein anatomy and LA dimensions/fibrosis were highlighted. Ultimately, he said, a tailored approach to treat individual risk factors such as obesity and blood pressure may be the best way of modifying the AF substrate and improving outcomes from AF ablation.

Published on: November 8, 2016

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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