Co-Author(s):
Maysam Al-Housari, MD
Hussein Khachfe, BS
Hamza Salhab, BS
Maurice Khoury, MD
Bernard Abi-Saleh, MD
American University of Beirut Medical Center
Cairo Street, Beirut, Lebanon
Introduction | Objectives: Atrial fibrillation (AF) and atrial flutter ablation are increasingly
used in clinical practice. We aimed to study the outcomes of ablated AF
and atrial flutters at a major tertiary referral medical center in
Lebanon.
Methods: We followed the last 99 patients after pulmonary vein isolation (PVI)
and flutters ablations performed at the American University of Beirut
Medical Center utilizing the circumferential mapping catheter technique,
Intracardiac Echography (ICE) and a 3D electroanatomic mapping system.
Typical flutters were ablated at the cavotricuspid isthmus under ICE
guidance, perimitral flutters were ablated by a left anteroseptal line
and the rest of the flutters had an activation map and/or an
entrainement map then ablated accordingly. All patients had failed at
least one antiarrhythymic drug (AAD). We documented recurrence of the
arrhythmia on and off AADs.
Results: Our patient population included 32% paroxysmal AF, 46 % persistent AF
and 22% long standing persistent AF. In the first six months after
ablation, 92% maintained sinus rhythm on and off AAD. Over a longer
follow-up (12 months), 83% maintained sinus rhythm. Off all
antiarrhythmic drugs 77 % had no recurrence of the arrhythmia at six
month follow up and 73 % maintained sinus rhythm without recurrence of
the arrhythmia at 12 months follow-up (Figure). Only five patients
underwent repeat ablations and this revealed conduction recovery in at
least 1 of the previously isolated PVs. The rest of the recurred
arrhythmias were either rate controlled or the patient decided to accept
a low burden of AF on an AAD. The procedure-related complication rate
was very low; one patient had a pseudoaneurysm requiring surgical repair
and one patient had a pericardial effusion that required drainage. None
had pulmonary vein stenosis.
Conclusions: Pulmonary vein isolation and atrial flutters ablation are safe and
efficacious for the maintenance of sinus rhythm in this Lebanese cohort
of patients with drug-resistant arrhythmias. They obviate the need for
antiarrhythmic drugs in a substantial proportion of Lebanese patients.
AFS 2021-37