ORIGINAL ARTICLES   

Minerva Cardioangiologica 2016 October;64(5):501-6

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

High intensity focused ultrasound ablation for atrial fibrillation: results from the National Spanish Registry

Guillermo REYES ¹, Xavier RUYRA ², Francisco VALDERRAMA ³, Antonio JIMENEZ ⁴, Dario DURAN ⁵, Enrique PEREZ ⁶, Tomas DAROCA ⁷, Javier MOYA ⁸, Ulises RAMIREZ ⁹, Gonzalo ALDAMIZ ¹⁰ ✉

¹ Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain; ² Department of Cardiovascular Surgery, Hospital Trias Pujol, Barcelona, Spain; ³ Department of Cardiovascular Surgery, Hospital Universitario Carlos Haya, Malaga, Spain; ⁴ Department of Cardiovascular Surgery, Hospital La Defensa Gomez Ulla, Madrid, Spain; ⁵ Department of Cardiovascular Surgery, Hospital Mexoeiro, Vigo, Spain; ⁶ Department of Cardiovascular Surgery, Hospital Universitario Virgen Macarena, Sevilla, Spain; ⁷ Department of Cardiovascular Surgery, Hospital Puerta del Mar, Cadiz, Spain; ⁸ Department of Cardiovascular Surgery, Hospital Reina Sofia, Cordoba, Spain; ⁹ Department of Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain; ¹⁰ Department of Cardiovascular Surgery, Fundacion Jimenez Diaz, Madrid, Spain

BACKGROUND: A National Spanish Registry to compile all patients treated with high intensity focused ultrasound (HIFU) energy for atrial fibrillation (AF) was created to evaluate the safety and efficacy of AF surgical ablation.
METHODS: A national Spanish registry was created, and ten hospitals using HIFU to ablate AF joined it. A total of 412 patients undergoing cardiac surgery between 2006 and February 2013 were included. AF was divided between paroxysmal AF (33%) and persistent AF (67%) with a mean AF duration of 29.3±108.2 months. Mean left atrial diameter was 51.2±6.5 mm. Mean underlying heart disease were aortic valve disease (49.3%), ischemic disease (25.2%) and mitral disease (33.2%) Clinical follow-up of patients and a 6 months postoperative echocardiogram were performed in all patients.
RESULTS: A pacemaker implantation was needed in 4.9% of patients with a perioperative stroke in 2.5%. Rhythm at discharge from hospital was sinus rhythm in 58%, AF in 35.9% and atrial flutter in 0.8% of patients. Sinus rhythm restoration at 6, 12, 24 and 36 months follow-up was achieved in 66.1%, 63.8%, 63.9% and 45.9% of patients respectively. Multivariate analysis showed paroxysmal AF and sinus rhythm restoration in the operating theatre as factors related to sinus rhythm long term restoration.
CONCLUSIONS: The Spanish national registry showed an efficacy of AF ablation with the HIFU Epicor system of 66.1%, 63.8%, 63.9% and 45.9% at 6, 12, 24 and 36 months follow-up. There were no device-related complications.