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  • Table shows the AF ablation procedure data

    2019-05-15

    Table 2 shows the AF ablation procedure data. The preoperative inspection consisted of transesophageal echocardiography and cardiac computed tomography (CT) in 79.9% and 80.8%, respectively; cardiac magnetic resonance imaging (MRI) was performed in only 1.1% of the patients. Two 3D mapping systems were used during PVI [16] in 94.8% of the patients: the CARTO system (Biosense-Webster Inc., CA, USA) in 72.5% and EnSite system (St. Jude Medical, MN, USA) in 22.3% of the patients. Irrigated catheters were used in 87.7% of the patients. The procedure time was 3.6±1.3h, and fluoroscopy time 72.9±52.7min. Table 3 shows the AF ablation strategies. Because PVI is considered the cornerstone of AF ablation, 97.6% of the patients underwent PVI. Ipsilateral encircling PVI [17,18] (79.7%) was the standard method; however, individual PVI (10.3%) [19] and box isolation (5.8%) [20] were also performed at some centers. Ablation adjunctive to PVI was performed in 78.5% of the patients. The CTI and mst1 kinase were ablated in 56.5% and 16.6% of the patients, respectively. Adjunctive ablation other than CTI ablation was performed in 453 patients (48.6%). The execution rate depended on the AF persistence: 38.3% in paroxysmal AF, 57.2% in persistent AF, and 82.1% in long-standing persistent AF (p<0.0001). LA linear ablation was performed in 25.5% of the patients; of those, the ablation was on the LA roof in 22.4% and at other sites in 17.6%. The rate of CFAE ablation was 13.1%, and consisted of LA CFAE ablation in 12.8% and right atrial CFAE ablation in 4.8% of the patients. LA linear ablation was performed more frequently than mst1 kinase CFAE ablation (p<0.0001). Seventy-four patients (7.9%) underwent both LA linear ablation and CFAE ablation. Finally, 98.7% of the AF ablation sessions resulted in sinus rhythm. Table 4 lists a comparison of the rates of ablation procedures based on the types of AF. CTI ablation was performed in 53.9%, 55%, and 70% of paroxysmal, persistent, and long-standing persistent AF patients, respectively (p=0.0022). There were no differences in the frequencies of SVC ablation and focal ablation between the AF types (p=0.38 and p=0.28, respectively). On the other hand, the rates of CFAE ablation and linear ablation were highest in the longstanding-persistent AF patients (32.1% and 63.6%) and lowest in paroxysmal AF (5.2% and 15%). Table 5 lists the complications of AF ablation. Pericardial effusions occurred in 29 sessions (3.1%), and emergency drainage of a cardiac tamponade was required in 10 sessions (1.1%). Symptomatic cerebral infarctions occurred in two patients (0.2%), and asymptomatic cerebral infarctions were diagnosed using CT or MRI in two patients (0.2%). Other major complications were a hemothorax in one patient; prolonged phrenic nerve palsy in one patient; gastric hypomotility in four patients; and an air embolism in one patient. No deaths were reported. Table 6 shows the prescriptions at discharge. Most patients (908, 97.5%) received oral anticoagulant (OAC) agents at discharge, such as warfarin in 761 patients (81.7%) and dabigatran in 147 patients (15.8%). Antiarrhythmic drugs were prescribed in 436 patients (53.6%); the three most frequently prescribed drugs were bepridil (18.5%), flecainide (10.6%), and pilsicainide (8.5%).
    Discussion The J-CARAF was created in order to assess the status of AF ablation in Japan today, as a supplement to the JHRS summary of the Japanese Catheter Ablation Registry (JCAR) [21,22]. This is RNA polymerase the first report of the J-CARAF, which describes the current indications, procedures, strategies, and complications of AF ablation in Japan.
    Conclusions
    Conflict of interest
    Introduction However, previous reports have reported the difficulty of RF ablation for AVNRT associated with PLSVC due to an enlargement of the coronary sinus ostium and deviation of the His bundle [1].
    Case A 33-year-old woman was referred to the emergency department at our hospital for sustained palpitations lasting more than 6h.