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Dr. Jose Luis Merino,
Dr. Perez-Villacastin, from Madrid, Spain, spoke about early recurrences of atrial fibrillation following pulmonary vein ablation, which may affect approximately 30% of patients. These episodes of arrhythmia are not only in the form of atrial fibrillation but also as atypical atrial flutter and tachycardia.
Their exact mechanism is unclear, and inflammation, radiofrequency-related proarrrhythmia, or delayed curative ablation effect may all play a role. For most authors, many of these episodes are transient and the patient presents no further recurrences at follow-up. The speaker and the symposium chairpersons discussed the possibility of waiting at least 3 months to repeat a second procedure. This presents some disavantages, such as the difficulty of discharging the patient and asking them to wait for a delayed cure. However, there are also some advantages, like performing the second procedure once the oedema (which may limit gap mapping and transmurality of radiofrequency application) caused from the former has disappeared. Carlo Pappone, from Milan, Italy, reviewed the complications during and after atrial fibrillation ablation. Cardiac tamponnade is one of the most frequent. It is important to have a high level of suspicion and to differentiate right-sided from from left-sided pericardial bleeding. Right-sided bleeding may become apparent after the procedure and shows lower oxygen saturation of the blood drained by pericardiocentesis. Atrio-oesophageal fistulae is another delayed complication which is lethal in more than half of patients. Ricardo Cappato, from San Donnato, Italy, commented that antiarrhythmic drugs are commonly used following atrial fibrillation ablation due to the aforementioned frequent transient early recurrences. These drugs should be divided into those aimed at suppressing symptoms, like class I and III drugs, and those aimed at improving symptoms, like betablockers and calcium antagonists. He considered of special interest the use of amiodarone because patients with transient early recurrences would benefit from this highly efficacious drug, but without the risk of significant side effects, which are seen when this drug is used for the long term. Finally, Prof. Le Heuzey, from Paris, France, reviewed the evidence for anticoagulation discontinuation following atrial fibrillation ablation. Many reports have shown that the closer patients are monitored, the more frequently asymptomatic atrial fibrillation episodes are detected at follow-up. Therefore, anticoagulation should be maintained in those with thromboembolic risk factors.
Ablation is becoming a well established therapy for atrial fibrillation, with few complications. However, because the arrhythmia mechanism is still unknown, this should still be considered an empiric treatment with relatively high recurrences, some of which are transient or asymptomatic.
The post-ablation atrial fibrillation patient
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