After more than ten years of exploration, radiofrequency ablation has become an important rhythm control tool in the treatment of atrial fibrillation, so who is suitable for radiofrequency ablation treatment? What is the effect? What is atrial fibrillation Atrial fibrillation (AF) is a supraventricular tachyarrhythmia in which uncoordinated atrial excitation occurs and leads to ineffective atrial contraction.
ECG features include an irregular R-R interval, loss of regular P waves, and replacement with irregular atrial fibrillation waves. The main symptoms include palpitations (irregular and fast heartbeat), shortness of breath, and fatigue. In patients with significant symptoms, AF seriously affects their quality of life. Atrial fibrillation classification 1, paroxysmal atrial fibrillation: atrial fibrillation episodes within 7 days, can be converted to sinus rhythm by itself or intervention therapy to convert, atrial fibrillation may recur at different frequencies. 2, persistent atrial fibrillation: atrial fibrillation duration >7 days, <1 year. 3, Long-term persistent atrial fibrillation: atrial fibrillation lasting >12 months. Permanent atrial fibrillation: The definition of permanent atrial fibrillation is used when the patient and physician jointly decide to abandon further attempts to restore and/or maintain sinus rhythm. Acceptance of the atrial fibrillation rhythm represents an attitude of the patient and physician toward treatment rather than a pathophysiologically inherent property of atrial fibrillation. Acceptance of the atrial fibrillation rhythm may change due to symptoms, the effectiveness of interventions, and changes in patient and clinician preferences. Radiofrequency Ablation Radiofrequency ablation of atrial fibrillation is a technique that applies radiofrequency energy at the tip of an intracardiac catheter to eliminate abnormal electrical activity in the atrial tissue. The principle is to apply radiofrequency current through the myocardial tissue to produce heat conduction to the deeper layers of the tissue. Generally at 50°C, most of the myocardial tissue will form irreversible coagulative necrosis into a myocardial scar that will not conduct and produce triggering activity, thus achieving the treatment of atrial fibrillation. Indications for radiofrequency ablation of atrial fibrillation Patients with symptomatic paroxysmal atrial fibrillation in whom at least 1 antiarrhythmic drug therapy is ineffective or intolerant or contraindicated; Patients with symptomatic persistent or long-range persistent atrial fibrillation in whom conventional drug therapy or electrical cardioversion is ineffective. In short, patients with paroxysmal or persistent atrial fibrillation may be considered for radiofrequency ablation after initial evaluation by a specialist clinician. The APAF study randomized patients with paroxysmal atrial fibrillation to the radiofrequency ablation and antiarrhythmic drug groups. 86% of patients in the radiofrequency ablation group had no recurrence of atrial arrhythmias after 1 year, compared to 22% in the drug group, and the rate of hospitalization for cardiac reasons after radiofrequency ablation was higher than in the drug group. A study published in JAMA in 2010 randomized patients with poor drug therapy to either the radiofrequency ablation group or to a different antiarrhythmic drug and found that 63% of the radiofrequency ablation group had no recurrence of atrial arrhythmias compared to 17% of the drug therapy group at 9 months. A newly published clinical study (RAAFT-2) found that the success rate of the radiofrequency ablation group for atrial fibrillation was 87.0%, with 13.6% of patients requiring a second procedure. For the primary endpoint, the recurrence rate of atrial arrhythmias at 24 months was 54.5% in the RF ablation group compared with 72.1% in the drug treatment group, suggesting that the RF ablation group was superior to the drug treatment group in terms of atrial fibrillation recurrence. In terms of secondary endpoints, the recurrence rate of symptomatic AF was also significantly lower in the RF ablation group, at 40.9%, while it was higher in the drug treatment group, at 57.4%. The quality of life in the radiofrequency ablation group was also significantly better than that in the pharmacotherapy group. According to the summary of all studies, radiofrequency ablation is superior to drug therapy in maintaining sinus rhythm, with sinus rhythm maintenance rates of 88%-92% for paroxysmal atrial fibrillation compared to 35.4%-87% for drug therapy at 1 year. For persistent atrial fibrillation, the sinus rhythm maintenance rate with radiofrequency ablation is 50%-88%, compared with 0%-7.7% with pharmacotherapy. It is important to note that some patients with AF require more than one RF ablation, and overall, the re-ablation rate is reported to be <43%, meaning that RF ablation is superior to drug therapy for paroxysmal AF with fewer long-term side effects, and significantly superior to drug therapy for specific patients with persistent AF. Some patients require secondary ablation, but it is not yet possible to determine which patients require secondary ablation. In conclusion, patients with atrial fibrillation should be seen by an arrhythmia specialist as soon as possible after diagnosis to assess their suitability for radiofrequency ablation therapy and to maximize the benefit of early diagnosis and treatment.