Changes and impacts in early recurrences after atrial fibrillation ablation in contact force era: comparison of high-power short-duration with conventional technique-FIRST experience data.

BACKGROUND OR PURPOSE: Different atrial tachyarrhythmias (AT) may be seen during follow-up after atrial fibrillation ablation. Evaluate and analyze characteristics and management of AT following first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) and its impact on late outcome. METHODS: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD with 71 and LPLD with 73 patients and no major clinical differences between the two groups. RESULTS: AT occurred in 60 patients (41.67%) in entire follow-up. HPSD 22 patients had AT: 13 during blanking period (BP) and 9 after that. LPLD: 38 patients with AT, 14 during BP and 24 after that. During BP, HPSD showed high rate of atrial flutter/tachycardia in 9 (69.23) of 13 and LPLD 4 (28.57%) of 14 patients. At 12 months' follow-up, 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD. CONCLUSIONS: HPSD ablation produced higher rates of early than late recurrence comparing to LPLD. Regular tachyarrhythmias were most common arrhythmia during BP with HPSD ablation and AF in LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months.

Routine Detection of Atrial Fibrillation/Flutter Predicts a Worse Outcome in a Cohort of Tetralogy of Fallot Patients During 23 Years of Follow-Up.

Atrial flutter/fibrillation (AFL/AF) is a late complication in adults with repaired tetralogy of Fallot (TOF). Its effects on long-term prognosis are not fully understood. We evaluate the impact of AFL/AF in adults with repaired TOF on global mortality and unplanned hospitalizations during follow-up, and the predictors for AFL/AF occurrence. The presence of AFL/FA was analysed in all exams performed during the last 10 years of outpatients follow up in a unicentric cohort of repaired TOF between 1980 and 2003. Two-hundred and six patients were included; at a mean follow-up of 21 ± 8.2 years, there were 5 deaths (19.2%) in the AFL/AF group and 2 (1.1%) in those without arrhythmia (p < 0.001). Patients with AFL/AF where older at the time of the surgical repair (p < 0.001) and had a higher rate of reinterventions (p = 0.003). No differences were observed between the groups regarding the use of a transannular patch, ventriculotomy and previous palliative shunt. QRS duration was longer in patients with AFL/AF (174 ± 33.4) when compared to those without arrhythmia (147 ± 39.6; p < 0.0001). Age at surgery, QRS duration, and tricuspid regurgitation ≥ moderate were independent risk predictors for AFL/AF. In the multivariate analysis, atrial flutter/fibrillation and QRS duration were predictors of death and hospitalization. AFL/AF is associated with an increased risk of death and hospitalization during the follow-up of patients with repaired TOF. Early detection of AFL/AF and their predictors is an essential step in the evaluation of such population.