PRIMARY RESULTS OF RF CATHETER ABLATION FOR AF IN VIETNAM HEART INSTITUTE. PHAM QUOC KHANH, MD, PhD. et al Vietnam Heart Institute

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1 PRIMARY RESULTS OF RF CATHETER ABLATION FOR AF IN VIETNAM HEART INSTITUTE PHAM QUOC KHANH, MD, PhD. et al Vietnam Heart Institute

2 Background - Forms of Atrial Fibrillation - Clinical type of AF: + paroxysmal <7days: self-terminating. + persistent > 7 days: require intervention termination. + permanent: refractory to cardioversion or accepted as final rhythm. -

3 Background - Prevalence of AFib General population-based prevalence 0.95% ATRIA study 2.5% Olmsted County study Go AS, et al. JAMA (2001) 285: 2370 Miyasaka Y, et al. Circulation (2006) 114: 119

4 Projected number of persons with AF (millions) Prevalence of AFib Olmsted County study Year Miyasaka Y, et al. Circulation (2006) 114: 119

5 At least one CV event (%) Increased Risk of Cardiovascular Events Death or hospitalization in individuals with CV event(s) after 20 years 100 Men 89 Women AFib No AFib AFib No AFib Stewart S, et al. Am J Med (2002) 113: 359

6 Mortality during follow-up (%) Mortality Associated with AFib Framingham Heart Study, n= Men AFib+ Women AFib+ 40 Men AFib- Women AFib Follow-up (y) Benjamin EJ, et al. Circulation (1998) 98: 946

7 Objectives 1. To evaluate the effect of RF catheter ablation for the treatment of AF 2. To study the applicability of this method for the clinical practice in Vietnam

8 METHODS 13 consecutive patients (12 male, 1 female) with AF: ( paroxysmal, persistent) Mean age:55,9 8,9 ( ) Multi-drug-resistant AF Serial MSCT before and 3 months after ablation 24-hour Holter and patients questionnaire at 3 months after procedure

9 Digitex 2400 Angiograph angiograph EP system Carto system

10 catheter positions

11 Ablation LIPV

12 CartoXP TM vs. CartoMerge TM CARTO XP: 79 pts. CARTO Merge: 82 pts.

13 AF ABLATION APPROACH Circumferential approach (WACA) (Pappone C et al., Circulation 2000; 102(21):2562-4) PV-Isolation (Haissaguerre M et al., N Engl J Med 1998; 339:659 65) Additional lines as needed.

14 Follow up Fu after 1 month (clinical examination, 24h-Holter- EKG, QOL) In hospital Fu at 3, 6 (clinical examination, Holter/Monitor, Echo, TEE, QOL; Lung scan and MRI as needed)

15 results and discussions 13 patients: + Age : 46-71; Average : 55,9 8,9 + Sex : M: 12 ; F: 1 + Biochemical test: normal + TEE: no thrombus in cardiac chambers. + Blood test: Normal. + Coronary angiography: - 3 : CHD - 10: Normal

16 ECHOCARDIOGRAPHY LA (mm) 36,3 4,3 Aotic (mm) 31 2,8 Dd (mm) 48,3 4,4 Ds (mm) 30,5 3,2 EF (%) 66,4 6,9

17 MSCT of LA RSPV (mm) 16,5 3,5 RIPV (mm) 25,1 4,2 LSPV (mm) 16,5 3,4 LIPV (mm) 15,1 3,2 Left atrial volume(cm3) 48,5 11

18 Arrhythmia Paroxysmal: n = 12 (92,3 %) Persistent: n = 1 ( 7,7%)

19 Classification of success Complete : 0 recurrences, 0 drug: Partial: 0 recurrences, + drug failure: + recurrences, + drug Clinical response: complete + partial success + Complete: 12/13 ( 92,3%). + Failure: 1/13: ( 7,7% )

20 Meta-analysis of Catheter Ablation Studies (I) Ablation method Patients Paroxysma l AF SHD 6-month cure 6-months OK Linear % 26% 33% 55% Focal % 35% 54% 71% Isolation 2,187 83% 36% 62% 75% Circumferential (all) 15,455 68% 37% 64% 74% Circumferential (LACA, WACA) Circumferential (PVAI) Substrate ablation (CFAE) 2,449 65% 37% 59% 72% 11,132 68% 42% 67% 76% % 49% 75% 87% TOTAL 23,626 61% 55% 63% 75% Cure (by each author s criteria) means no further AFib 6 months after the procedure in the absence of AAD. OK means improvement (fewer episodes, no episodes with previously ineffective AAD). SHD indicates structural heart disease. Fisher JD, et al. PACE (2006) 29: 523

21 Meta-analysis of Catheter Ablation Studies (II) Condition / Type of AFib Patients Paroxysma l AFib SHD 6-month cure 6-months OK No structural HD 1,026 86% 3% 81% 72% Structural HD % 100% 74% 79% Paroxysmal AFib 3, % 23% 64% 73% Persistent Permanent AFib 3,741 0% 82% 66% 74% Cure (by each author s criteria) means no further AFib 6 months after the procedure in the absence of AAD. OK means improvement (fewer episodes, no episodes with previously ineffective AAD). SHD indicates structural heart disease. Fisher JD, et al. PACE (2006) 29: 523

22 Worldwide Survey on Efficacy and Safety of Catheter Ablation for AFib Total success rate: 76% Of 8745 patients: 27.3% required 1 procedure 52.0% asymptomatic without drugs 23.9% asymptomatic with an AAD within <1 yr Highly variable outcome between centres Cappato R, et al. Circulation (2005) 111: 1100

23 Results from Pioneering Centres Total success rate: 75-88% Parox, SHD, Study Year Follow-up Age, y % % Tool(s) End point AF Free (Off drugs), % Follow-up, d Ouyang et al ± NA CART O PV Isolation Haïssaguerre et al ± 8 NA 43 Fluoro PV Isolation Mansour et al ± CART O PV Isolation Marrouche et al ± ICE PV Isolation Oral et al ± CART O EGM Reduction Pappone et al ± CART O EGM Reduction Total Verma A & Natale A Circulation (2005) 112: 1214

24 COMPLICATION RATE (n= 13) Complications Rate Transient ischemic attack 0% Stroke permanent 0% Tamonade/ perforation 1 /13 (7,7%) Severe vascular access complication 0%

25 Complication rates

26 Consuming time and fluoroscopy time in procedures Fluoroscopy time (minutes) Cosuming time(minutes) Patients (n=13) 56,5 18,4 266,6 62,8

27 Case report 61-year-old gentleman Smoker but quit several years ago. No hypertension, no diabetes Symptomatic paroxysmal AF not responded to Amiodarone (300 mg/day)

28 Blood test: Normal (Creatinin: 110 mcmol/l) Chest X-ray: Normal cardiac silhouette, clear lungs TTE and TEE: Dd 51 mm; EF 71%, very mild MR, no thrombus in LA Coronary MSCT (12/2006): < 50% narrowing of proximal RCA

29 MSCT of LA and PVs LA dimensions are 54 mm x 26 mm x 55 mm (LR x AP x SI, respectively). Estimated LA volume: 41 ml LSPV: 18,3 mm; LIPV: 17 mm; RSPV: 18,7 mm; RIPV: 18,1 mm

30 A PV

31

32

33 PV Antrum Isolation RAO LAO

34

35 conclusion 1. RF catheter ablation can cure paroxysmal and persistent AF with high successfull rate 2. Further training and development of the electrophysiology program are needed to improve the availability of this modality of treatment for AF in Vietnam.

36 THANK YOU FOR YOUR ATTENTION

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