br Methods br Results In patients
Results In 22 patients, we analyzed 82 sites at which HFS was delivered. We identified 57 GP-positive sites on the basis of a vagal response (19 at the MTGP, 18 at the SLGP, and 20 at the ARGP) and 25 GP-negative sites. After delivery of radiofrequency direct renin inhibitors (30–35W for 30s) to the 57 GP-positive sites, HFS was applied to the same sites. The vagal response disappeared at 41 sites and was still present at 16 sites (Fig. 2).
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Introduction Catheter ablation has become an effective and established therapy for atrial fibrillation (AF). Many clinical studies have surveyed various aspects of AF ablation, such as the incidence of complications, success rate, and cost effectiveness. Constant effort is mandatory to confirm whether catheter ablation in each country is performed in a way that meets the international standard . The Japanese Heart Rhythm Society (JHRS) carried out a nationwide survey of AF-related catheter ablation: the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF). The aim of this survey was to collect the objective data to manage the performance and safety of AF ablation in Japan. Although some clinical studies have reported that AF ablation is a better choice than antiarrhythmic drug (AAD) therapy for the maintenance of sinus rhythm, AADs are often prescribed empirically to prevent AF recurrence or to alleviate the AF burden even after catheter ablation [2–5]. In this report, we focus on the use of AADs before and after AF ablation. The aim of this analysis was to offer a perspective of the current status of hybrid AF therapy in Japan.
Material and methods The method of this survey was previously reported . In short, the survey was performed retrospectively using an online questionnaire. JHRS members were notified by e-mail. Data were collected on patients\' backgrounds, methods of pulmonary vein isolation and related techniques, complications, and pre- and post-procedural pharmacological treatments in AF ablation procedures performed in September 2011, May 2012, or September 2012. Patient data included age, gender, AF ablation procedure history, AF type (paroxysmal [PAF], persistent, or long-standing [LS] persistent), frequency of AF attacks of PAF, risk factors associated with thromboembolism, structural heart disease, and echocardiographic parameters.
Results One hundred and seventy-nine EP centers reported AF ablation data (Appendix A). Information from a total of 3373 sessions was collected. Table 1 shows the patients\' backgrounds. The average patient age was 62.2±10.6 years, and 76.1% (2587) were male. Of all sessions, 77.4% were first AF ablation sessions, 19.1% were second sessions, and 3.5% were subsequent sessions. Patients with PAF constituted 64.4% (n=2173), while persistent and LS-persistent AF were 21.7% and 13.8% (n=733 and 467), respectively. Clinical profiles of three AF types are shown in Table 1. Patients with PAF had a history of previous pharmacological antiarrhythmic treatment more frequently compared to that in patients with persistent AF and LS-persistent AF. In total, 79.5% of patients (2560/3373) received prior AAD therapy. The average number of antiarrhythmic drugs used before AF ablation was 1.13±0.96. Table 2 shows the distribution of the number of AADs used in each of the AF types. Among 2173 PAF patients, 454 subjects (20.9%) underwent AF ablation without preceding AAD therapy. The number of subjects treated with each AAD is shown in Table 3. At the time of discharge, 49.6% of patients were treated with one or two AADs. A larger proportion of persistent AF patients and LS-persistent AF patients were given AADs than PAF patients (Fig. 1). Namely, 40.3% of PAF patients were discharged under AAD treatment, while 63.0% of persistent AF patients and 71.5% of LS-persistent AF patients left the hospital with AAD therapy (p<0.0001). Bepridil was most frequently prescribed (17.4%, Table 4). Flecainide and pilsicainide were used in 9.4% and 8.0% of patients, respectively. Amiodarone was prescribed in 5.8% of patients.