A fourteen-year experience on treatment of atrial fibrillation with radiofrequency ablation in Thailand: a real-world report from South East Asia

Type of funding sources: None.

Atrial Fibrillation ablation has been performed for more than 10 years, but the result of the procedure varied across centers. In Western world freedom from AF after ablation with PVI technique was 81.6% at 12 months, 73.8% at 24 months, and 68.1% at 36 months. No earlier report of outcome in South East Asia region. The study sought to report outcome of AF ablation in Thailand.

We performed a retrospective analysis of consecutive patients who were treated with atrial fibrillation ablation at a tertiary care, academic medical center between the years 2006 to 2020. Patient characteristics and outcome of ablation were collected. Patients were followed until the last follow up. Chi-square, ANOVA and survival analysis were analyzed.

Among 171 patients, 94 patients (55%) went through Pulmonary vein isolation (PVI), 55 patients (32%) went through CFAE ablation, 22 patients (13%) went through PVI plus CFAE ablation. Most of the patients were diagnosed with paroxysmal atrial fibrillation (154 patients, 90%). Time from diagnosis to ablation was 34.5 months (SD = 34.6) Median CHADVASC was 1 (IQR 0-2). Mean LVEF was 62% (SD = 12.2). Mean LA size was 37.5 mm. (SD = 7.4). Freedom from AF in all techniques was 73% at 12 months, 66% at 24 months and 55% at 36 months. The successful result from PV isolation was 79% at 12 months, 74% at 24 months and 59% at 36 months. CFAE ablation technique yield success rate 63% at 12 months, 51% at 24 months and 47% at 36 months.  The success rate between techniques were not statistically significant (P = 0.4) Subgroup analysis of obesity and non- obesity separate by BMI ≥ 25 and BMI < 25, in obesity patients freedom of AF after single catheter ablation 71% at 12 months (95% CI 0.6-0.8), 68.6% at 24 months (95% CI 0.57-0.81), 55% at 36 months (95%CI 0.42-0.71), In non-obesity group freedom of AF was 76.7% at 12 months (95% CI 0.67-0.87), 63.8% at 24 months (95%CI 0.52-0.77), 54.5% at 36 months (95% CI 0.42-0.69). There was no statistical significant different in success rate of AF ablation between these groups with P = 0.76

The overall success rate of AF ablation from our study was similar to western world. PV isolation tends to yield the highest success rate follow by CFAE ablation technique but no statistical significant. PVI plus CFAE ablation does not yield higher successful result.

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