ADVERSE PROGNOSTIC FACTORS FOR THE CATHETER ISOLATION OF PULMONARY VEINS OSTIA EFFICACY IN PAROXYSMAL ATRIAL FIBRILLATION WITH NO ORGANIC HEART PATHOLOGY (THE PRUF STUDY)

Abstract

Aim. To investigate on the prediction factors and main parameters of patients that influence catheter isolation of pulmonary veins ostia (PVO) in paroxysmal atrial fibrillation (AF) with no organic pathology of the heart. Material and methods. The PRUF study is single-center, prospective, comparison, open, randomized trial with control group. Subanalysis of PRUF reported, that included total efficacy of catheter ablation of PVO in one or two procedures, with comparison of prediction factors and main characteristics of the included patients, that influence outcomes. Totally, 243 patients were included after effective catheter isolation of PVO. Of those 142 (58,44%) were males, 101 (41,56%) females, mean age — 56,09±10,14 y.o. with arrhythmia anamnesis 4,48±2,6 years. Efficacy of operation was assessed based on the analysis of registered rhythm disorder episodes by subcutaneous ECG registration, Holter monitoring and standard ECG. Results. In a year of follow-up after catheter ablation of PVO the overall efficacy was 66,6%, n=162, 95% confidence interval (CI) 61-72%; after the two 88,5%, n=215, 95% CI 84-92%. After one procedure: mean age of non-affective patients was 53,3±10,67 vs 57,48±9,6 y.o. of effective (p=0,002). In comparison of echo parameters of the left atrium diameter (LA) in non-effective was 4,22±0,28 vs 4,12±0,27 in effective (p=0,007). By the comorbidities: arterial hypertension (p=0,35), chronic heart failure (p=0,64), diabetes (p=0,57) there were no difference, however by thyroid gland there was significant difference in hypothyroidism in anamnesis (p=0,033). Comparing the same properties after two procedures: mean age of non-effective was 54,32±10,12 vs 57,09±9,62 y.o. of effective (p=0,18), LA diameter in non-effective 4,28±0,29 vs 4,11±0,27 in effective (p=0,004). For thyroid pathology, there was also significant difference in hypothyroidism in anamnesis in non-effective group 32,14% vs 10,19% effective (p=0,005) and by hyperthyroidism in anamnesis 7,14% vs 2,78% (p=0,011). Conclusion. The LA size is a prediction factor for the efficacy of catheter PVO in paroxysmal AL patients with no organic pathology of the heart (p<0,005). Younger patients needed more repeated interventions for an effective outcome (p=0,002 after one isolation of PVO and p=0,18 after the two). From the comorbidities, as an adverse factor of efficacy there was thyroid pathology in anamnesis, in either one or two interventions.

Keywords

• atrial fibrillation
• radiofrequency ablation of the pulmonary veins ostia
• early post-surgery period
• verapamil
• propafenon
• sotalol
• the pruf study