Dr. Lluis Mont

1. Ablación de FA Cómo seleccionar los candidatos a la técnica Hospital Clinic. University of Barcelona

7. Paroxística vs persistente vs larga duración FA de larga duración: permanente durante más de 1 año

8. Chronic Atrial Fibrillation Oral et al. N Engl J Med 2006

9. Chronic Atrial Fibrillation (persistent and permanent) Oral et al. N Engl J Med 2006 30% second ablation

10. APAF. Pappone et al. JACC 2006

11. APAF. Pappone et al. JACC 2006 10 % redo in the ablation group

12. Ablation of Persistent AF (includes permanent AF) Knecht et al. Eur Heart J 2008 Grupo A, FA termino sin lesiones lineales Grupo B. FA requirió lesiones lineales

13. Recurrence of Atrial Tachycardia after a single procedure Knecht et al. Eur Hear J 2008 Group B includes PV isolation + ablation of CAFES + roof and mitral lines

15. Predictors of success Hospital Clinic Barcelona

17. Multivariable analysis Long-standing AF > 1 year in continous AF

18. 70% arrhythmia free probability at 1 year

19. Paroxysmal AF at the Emergency Room of Community Hospitals In Catalonia (n = 300 patients) Planas et al. Rev Esp Cardiol 2001 Success depends also on etiology

21. Treat and control etiologic factors if possible: seems obvious but it is not!

24. CPVA Pre-procedural Predictors of success Berruezo et al, EHJ 2007

25. AF ablation in HCMP. n = 33 Bunch JCVE 2008 4 (12%) History of CVA/TIA 5 (15%) Sleep apnea 3 (9%) CAD 2 (6%) Diabetes 35 (21%) Hyperlipidemia 8 (24%) Hypertension 4 (12%) Family history of AF 13 (39%) Prior AF ablation 2.0 ± 1.3 Failed antiarrhythmic medications (number) 6.2 ± 5.2 AF duration (year) 25 (76%) Gender (male) 51 ± 11 Age (year)

26. AF ablation in HCMP. n = 33 Bunch JCVE 2008 No reported redo procedures. No reported atrial tachycardia

27. RF ablation in prosthetic mitral valve patients. A case-control study Lang CC. JACC 2005 p Value Control Subjects (n = 52 ) MVP Patients (n = 26) — 16 ± 7 Duration of MV disease (yrs) 0.06 27 (52%) 6 (23%) Hypertension 0.14 36 (69%) 22 (85%) Duration of AF >2 yrs 0.51 34 (67%) 15 (58%) Patients previously cardioverted 0.70 22 (42%) 13 (50%) Previous amiodarone 1.00 26/26 13/13 Arrhythmia (PAF/CAF) 0.65 55 ± 5 55 ± 5 Left atrial diameter (mm) 0.33 26/26 10/16 Gender (men/women) 0.71 55 ± 10 57 ± 9 Age (yrs)

28. RF ablation in prosthetic mitral valve patients. A case-control study 23 % Atrial tachycardia in Mitral prosthesis 2 % Atrial tachycardia in the control group P< 0.05 Recurrences of AF Lang CC. JACC 2005

30. M. Matiello, L. Mont, D. Tamborero, A. Berruezo, J. Brugada Instituto del Tórax, Hospital Clínic, Barcelona Low Efficacy of Atrial Fibrillation Ablation in Obstructive Sleep Apnea Syndrome Patients . ESC 08

32. Recurrences after 1.3 procedures per patient log-rank p= 0,035 log-rank p= 0,235 Matiello et al. ESC 08

33. Multivariate OSAS and left atrium diameter were independent predictors of AF recurrence. < 0.001 3.36; (1.83-6.15) OSAS high risk < 0.001 1.10; (1.04-1.16) Left atrium diameter P HR; (95% CI)

34. Systolic heart failure is not a predictor of outcome after atrial fibrillation ablation De Potter et al. ESC 08

36. Patient characteristics

39. Follow-up EF data De Potter et al. ESC 08

41. 59 (32%) 120 (66%) 39 (21%) 23 (13%) 32 (18%) 107 (59%) 64 (35%) 42 (23%) Hypertension Type of AF Paroxysmal Persistent Long standing Structural heart disease Lone AF Endurance sports* Lone AF Sport group** 148 (81%) Male gender 51  11 Age (yrs) 182 Patients Baseline characteristics

42. 0.479 0.821 (0.475-1.419) Lone AF sport group 0.011 1.057 (1.013-1.104) LAD (mm) 0.940 1.00 (0.997-1.003) AF duration (months) 0.821 0.931 (0.501-1.729) Structural Heart Disease 0.005 0.535 (0.344-0.831) Paroxysmal AF 0.098 1.576 (0.912-2.723) Hypertension 0.869 1.048 (0.598-1.838) Male gender 0.742 1.004 (0.983-1.025) Age (years) P Value Hazard ratio (95% CI)

43. Probability of recurrence of patients with sport-associated LAF and controls 60 50 40 30 20 10 0 Months 1,0 0,8 0,6 0,4 0,2 0,0 Cumulative survival free of AF Si-censurado Lone AF sport group Control group Long rank test: 0,446

45. AF ablation

49. AF-free after 1 procedure

51. AF-free after N procedures 20% more than 1 procedure

53. Ablation evolution

54. Imatge Lasso Escòpia (1)

55. Imatge Lasso Escòpia (2)

56. Captura local estimulant des de Lasso, bloqueig de sortida (+Far Field)

58. Tamborero et al, JCVE 2007 0.268 38.1±9.8 40.2±11.5 <0.001* 26.9±10.2 37.4±10.1 FE AI (%) 0.315 75.8±24.3 78.4±22.2 0.004* 52.2±12.1 58.6±16.1 AImin (ml) <0.001* 103.5±28.1 126.2±32.8 <0.001* 84.9±17.1 98.0±19.9 AImax (ml) p Post Ablación Pre Ablación p Post Ablación Pre Ablación Recurrences (n =17) Arrhythmia free (n =38)

59. Decrease in LA volume 13±12% vs 17±14%, p=0.22 Tamborero et al, JCVE 2007

60. Events during follow up in Lone AF Osranek. Eur Heart J 2005

61. June 2007, the 500 AF ablation celebration and still learning how to do it!