Radiofrequency catheter ablation +EPS guided trigger and substrate ablation for Atrial Fibrillation

For those who do not suffer a stroke from atrial fibrillation, the risk of an ischemic stroke or transient ischemic attack is 5-10%/year. For those with a stroke or TIA from atrial fibrillation, the risk of death or further embolic strokes is 1.0-3.8%/year. There is a 25% increased risk of death from any causes after a stroke of atrial fibrillation compared with stroke-free age-matched patients, and a 70% increased risk of death from all causes, including cardiac and noncardiac causes, after atrial fibrillation compared with stroke-free age-matched patients.

Atrial fibrillation is a common condition, particularly so in the elderly. It is a type of arrhythmia which is relatively resistant to treatment, with frequent recurrences and a high rate of sudden death.

With the use of this methodology, we estimated that there were more than 650,000 new cases of atrial fibrillation and atypical atrial flutter (AAF) in the United States in 2005. Although the estimates had a low likelihood of error, the number of new AAF cases was similar to that estimated for the U.S. overall at least during the 5-year period 2001-2005. These data also support the use of direct extrapolation method to estimate incidence of atrial fibrillation, for evaluating the burden of AF in the U.S. Results from a recent clinical trial suggested that AF accounts for more than 4% of all cardiovascular hospitalizations in the U.S.

The presence of valvular dysfunction and hypertension in patients with atrial fibrillation were not associated with prolonged fibrillation duration. The presence of a family history of atrial fibrillation and the presence of left ventricular hypertrophy were inversely associated with duration of atrial fibrillation.

As many as 40% of people with AF have no identifiable trigger. However, many of those with identifiable triggers have an underlying disorder that is responsible for this phenomenon. Physicians should consider a thorough medical evaluation when they feel AF may be secondary to another problem(s).

The most common treatment is anti-arrhythmic drug therapy for atrial fibrillation with or without cardioversion followed by implantation of an cardiac defibrillator, and/or surgical ablation.

An important limitation of many of the studies on AF is that they are too recent to address whether AF is cured. The majority of AF patients were treated with anticoagulants, which may have contributed to the reported higher risk of fatal stroke.

Approximately 60% of patients (mean age of 43.2 years) presenting to the emergency department with AF had been symptomatic (nausea, vomiting, chest pain, or shortness of breath) for no more than the past month. Of the remainder, 5.1% were asymptomatic or had only a recent history of AF. If atrial fibrillation develops later in life, the risk of complications increases.

The present findings indicate that ablation of AF by RF catheter ablation combined with epss guided substrate ablation is safe in terms of the risk of death and of stroke.

We found that atrial fibrillation occurs in more hypertensive individuals and more with obesity, with increased resting heart rate and with a higher presence of coronary artery disease.