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RF Ablation of AF First Line Treatment: Pro

RF Ablation of AF First Line Treatment: Pro. Dipen Shah MD, Hopital Cantonal Universitaire de Geneve , Switzerland. Cairo Heart Rhythm 2010. Afib Ablation at the HUG: 2002-2008 487 patients. Patient characteristics. Procedural characteristics.

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RF Ablation of AF First Line Treatment: Pro

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  1. RF Ablation of AF First Line Treatment: Pro Dipen Shah MD, Hopital Cantonal Universitaire de Geneve, Switzerland Cairo Heart Rhythm 2010

  2. Afib Ablation at the HUG: 2002-2008487 patients Patient characteristics Procedural characteristics

  3. Fewer Complications: Learning Curve Effect n=9075 patients 100 centers 2002 n=1011 patients 10 centers 2005

  4. 32 patients – PVI 35 patients – AAD One year FUP: PVI: 87% AF free AAD: 37% AF free Wazni et al, JAMA 2005, 293, 2634-2640

  5. Results with drugs do not depend upon experience! For antiarrhythmic drug treatment Initial episodes of AF Unsuitable or poor candidates for ablation Failure of ablation ?Asymptomatic AF Unsuitable for antiarrhythmic drug treatment Concomitant bradycardia Other side effects Heart failure, syncope or embolic complications favour a more effective nonpharmacologic treatment Antiarrhythmicdrugs vs. PVI for rhythm control

  6. RF AAD n= 53 n= 59

  7. Kerr et al, Am Heart J 2005; 149: 489-496 8.6% & 24.7% progression to chronic AF by 1 & 5 years Jahangir et al, Circulation 2007; 115: 3050-56 31% progression to permanent AF over 25±10 yrs f-up. Nieuwlaat et al, Eur Heart J 2008; 29:1181-9 Within 1 yr, 20% PAF progressed Within 1 yr, 30% persistent became permanent AF AF Progression

  8. AF with reversible causes : pneumonia, hyperthyroidism, pericarditis, recent heart surgery Rhythm control preferred initial therapy in highly symptomatic patients First episode of AF may not recur for a long time..even without specific treatment Anticoagulation should not be hastily discontinued after restoration of sinus rhythm – continue for 12 rather than 4 weeks. Initial AF

  9. Catheter Ablation as First-Line Treatment of AFib • Young very symptomatic patients • who refuse long term AADs and anticoagulation • Young patients with parox/persistent AF and sinus node dysfunction • Endurance athletes with paroxysmal AF • Brady-tachy syndrome and parox AF • Parox AF with Brugada pattern ECG/Brugada syndrome Padanilam, et al, Circulation 2005, 112, 1223-9

  10. European Heart Journal doi:10.1093/eurheartj/ehq278 ESC GUIDELINES 2010

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