LONG-TERM OUTCOMES OF CATHETER ABLATION PULMONARY VEINS ON EXAMPLE OF A CLINICAL CASE PATIENT WITH PAROXYSMAL ATRIAL FIBRILLATION
Abstract
Catheter ablation of the pulmonary veins is the method of choice for the treatment of patients with symptomatic paroxysmal atrial fibrillation (AF). However, there are may be complications or recurrence of AF paroxysms and as we have described in our clinical case 2 after ablation really important to conclude that ablation does not eliminate drug therapy, but modifies it.
According to recent studies it has been demonstrated that pulmonary vein CA has favourable outcomes at 6–12 months post-ablation, but there are only few studies with a long-term follow-up and, as we see on our clinical case, after 2 years patient present with current deterioration of AF. The vast majority of very longstanding paroxysmal/persistent AF patients maintained sinus rhythm at a mean follow-up time of 5 years following CA, associated with a significant improvement in symptom scores and, as we see on our clinical case, after 2 years patient maintained sinus rhythm, but with recurrence paroxysms of AF for last year with mild/moderate of symptom scores. Often this procedure is not a radical solution of the problem, and most patients (as it also was shown on the example of our clinical case) are require adjunctive therapies including antiarrhythmics, DC cardioversions and re-ablation and upstream therapy (antihypertensive drugs and so on). Also our patient needs correction of the treatment of arterial hypertension and more properly diagnosis (and treatment) of thyroid disorder, and improvement the regulation at all levels - from the daily rhythm of the HR up to relations in the activity of the vagal activity branches, first of all, interventions in the lifestyle and searching for the optimum time drug administration. Of course, consider the presence of multiple syndromes on presented clinical case, we must not forget about the problem of polypharmacy and try to avoid it (many studies in ambulatory care define polypharmacy as a medication count of five or more medications, but it is practically impossible to investigate the biochemical compatibility in vivo of more than 4 drugs).
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References
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) [Electronic source] // European Heart Journal. – 2016. – Link: http://eurheartj.oxfordjournals.org/content/ehj/early/2016/09/08/eurheartj.ehw210.full.pdf
Long-term outcomes after ablation of persistent atrial fibrillation: an observational study over 6years / G.Wynn, M. El-Kadri, I. Haq, M. Das. // Open Heart. – 2016. - Vol. 3, Is. 2. - P. 1–10.
Estimated glomerular filtration rate reversal by blood pressure lowering in chronic kidney disease: Japan Multicenter Investigation for Cardiovascular DiseaseB CKD study / [Y. Yui, K. Kodama, A. Hirayama etc.]. // Journal of Clinical Hypertension. – 2012. – Vol. 15. – P. 171–175.
Mikhailidis D. The Role of Infection in Carotid Plaque Pathogenesis and Stability: The Clinical Evidence / Dimitri P. Mikhailidis. // Current Vascular Pharmacology. – 2010. – Vol. 8, Is. 6. – P. 861–872.
Stroobandt R. Propafenone for conversion and prophylaxis of atrial fibrillation. Propafenone Atrial Fibrillation Trial Investigators / R. Stroobandt, B. Stiels, R. Hoebrechts. // American College of Cardiology. – 1997. – Vol. 79, Is. 4. – P. 418–423.
Lepillier A. A 5-year clinical follow-up after duty-cycled phased RF ablation of paroxysmal atrial fibrillation [Electronic source] / A. Lepillier, G. Lascault, O. Paziaud // Journal of interventional cardiac electrophysiology. – 2016. – Link: https://www.ncbi.nlm.nih.gov/pubmed/27878420.
Alcaraz R. Noninvasive time and frequency predictors of long-standing atrial fibrillation early recurrence after electrical cardioversion / R. Alcaraz, F. Hornero, J. Rieta. // North American Society of Pacing & Electrophysiology. – 2011. Vol. 34, Is. 10. – P. 1241–1250.
Golubkina E. O. Assessment of changes in the distribution ratios of ultra-low-frequency, low-frequency and highfrequency components of heart rate variability during the paced breathing test in patients with arterial hypertension / E. O. Golubkina // The Journal of V. N. Karazin Kharkiv National University, series «Medicine». – 2016. – Is. 31. – P. 10–17.
Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud [Electronic source] // Pharmacoepidemiology and drug safety. – 2016. – Link: https://www.ncbi.nlm.nih.gov/pubmed/27730699.
Polymorbidity does not determine polypharmacy / [A. I. Lakhonina, A. V. Filatova, N. V. Makienko etc.]. // The Journal of V. N. Karazin Kharkiv National University, series «Medicine». – 2015. – Is. 30. – P. 45–48.
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