1 / 24

Disclosures*

Long-term Efficacy and Safety of Catheter Ablation for AF: What is the Evidence? AHA QCOR Washington DC D. George Wyse MD PhD May 20, 2010. Disclosures*. PHRI – Population Health Research Institute – McMaster University DCRI – Duke Clinical Research Institute; Mayo – Mayo Clinic

nvue
Download Presentation

Disclosures*

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Long-term Efficacy and Safety of Catheter Ablation for AF: What is the Evidence?AHA QCOR Washington DCD. George Wyse MD PhDMay 20, 2010

  2. Disclosures* PHRI – Population Health Research Institute – McMaster University DCRI – Duke Clinical Research Institute; Mayo – Mayo Clinic Axio – Axio Research Corporation U. Penn – University of Pennsylvania * All < $10,000

  3. Outline • Key Patient Characteristics of RCT of LA/PV RFA and AAD • Quantitative “Gradient” between Groups of SR vs. AF in AAD vs. RFA RCT • Goals for Therapy of AF • Reduce Mortality • Prevent Stroke/SE • Preserve/Improve Ventricular Function and Prevent CHF • Relief of Symptoms • RFA of AV Junction and Pacemaker

  4. Age and Duration of Follow-up in RTCof LA/PV Catheter Ablation for RFA AAD RCT: AFFIRM, AF-CHF & ATHENA N = ~ 10,000 Mean Age = 70y Mean FU = 4.5y Table unpublished, courtesy of Win Shen – Mayo University

  5. Quantitative “Gradient”SR vs. AF; AAD vs. RFA Gradient = 70% PABA-CHF – not “prevalence” Gradient = 40% Gradient = 40% AF-CHF AFFIRM New Engl J Med 2002;347:1825 New Engl J Med 2008;358:2667 New Engl J Med 2008;359:1778

  6. Goals of Therapy for AF

  7. Reduce Mortality

  8. Death After RFA for AFShort-term Based on 45, 115 procedures in 35, 569 patients between 1995-2006 = 0.98 per 1,000 JACC 2009;53:1798 Percent Circulation 2005;111:1100

  9. Death After RFA for AFLong-term • 65 ± 9 years • PAF = 69% • No CV Dis = 34% • LVEF = 54 ± 12% • Death in RCT vs. AAD • RR = -0.003 (95% CI • -0.01- 0.02; p = 0.74) • Am Heart J 2009;158:15 + Annual Mortality in AFFIRM ~ 3.5% J Am Coll Cardiol 2003;42:185

  10. Prevent Stroke/SE

  11. Stroke/TIA from RFA for AFShort-term“Yin-Yang” of Anticoagulation Percent Circulation 2005;111:1100

  12. Stroke/SE after RFAShort-term • Stroke in RCT vs. AAD • RR = 0.004 (95% CI • -0.01-0.02; p = 0.54) • Am Heart J 2009;158:15 Circulation 2006;114:759

  13. Impact of Absence of AF on Stroke * Neurology 1993;43:32 & Arch Intern Med 2005:165:1185

  14. Perception of AF after RFA Episodes of AF % Episodes with No Symptoms Circulation 2005;112:307

  15. AF Patterns Before/After AF Ablation with 24/7 Monitoring • “Permanent Cure” after 3 mo blanking = 3/14 J Cardiovasc Electrophysiol 2007;18:818

  16. Preserve/Improve Ventricular Function & Prevent CHF

  17. RFA and LV FunctionA meta analysis of RCT A = RR for reduced LVEF vs. normal LVEF B = Absolute % LVEF after vs. before RFA

  18. Relief of Symptoms

  19. SymptomsAblation vs. AAD • Symptomatic AF • Failed at least 1 AAD • No amiodarone in 6 months • LA diameter <5cm • Mean age = 56y • Mean follow-up = 13 months J Am Med Assoc 2010;303:333

  20. Symptoms of AFCCS- SAF Class N = 484 Percent Symptom Class Circ Arrhythmia EP 2009:2;218

  21. CABANA TrialDesign R

  22. Ablate [and Pace]

  23. Effects of AV Junction Ablation & PaceA Meta Analysis Circulation 2000;101:1138

  24. PACIFIC Trial Pilot R

More Related