Results
Patient Characteristics: A total of 166 atrial arrhythmia cases
were guided by the HD Grid from May 2018 to December 2019, with 151
patient procedures meeting our inclusion criteria accounting for 142
patients. Fifteen patients were excluded due to AVRT (7) and typical
cavotricuspid isthmus dependent flutter (8). Atrial fibrillation (AF)
accounted for the majority of cases (68.9%), with 66 paroxysmal cases
and 38 persistent cases; the remainder of the cases were classified as
atrial tachycardia (including a focal or re-entrant, incisional
pathology), 29 (19.2%) cases and atypical atrial flutter
(macro-reentrant), 18 (11.9%) cases. The majority of patients were male
(67.8%) with a mean age of 61.1 ± 11.2 years. A detailed summary of
patient demographics are described in Table 1.
Procedural Details: General anaesthesia was administered for 84
cases with a mean procedure time of 237.8 ± 75.6 minutes and mean
cumulative fluoroscopy dose of 137.9 ± 134.8 mGy. Intracardiac
echocardiography was employed for 23 procedures. Radiofrequency (RF)
lesions applied for each respective atrial arrhythmia case are described
in Table 2. Acute procedural success was observed in all patients,
defined as pulmonary vein isolation, the identification and termination
of clinical arrhythmia, and demonstration of bidirectional block when
applicable.
Post-operative Complications: Three patients experienced major
complications within 30 days post-procedure including pericardial
tamponade, TIA, and stroke. Both embolic events occurred 3 days
post-procedure; the TIA occurred in a patient non-compliant with
anticoagulation upon returning home and the stroke patient had
significant co-morbidities. Both patients made a complete neurological
recovery. Minor complications were reported for three patients including
one reported case of urinary retention and two cases of pericarditis
that responded to conservative management without any prolonged hospital
stay.
Follow-up and Arrhythmia Recurrence: Patients were followed-up
for a mean 185.2 ± 134.3 days post-procedure and one patient was lost
to follow-up. One patient died from complications of septic arthritis
183 days post procedure. Long-term outcome data is presented for the
remaining 150 patients described in Table 3; 32 (21.2%) reported an
arrhythmia recurrence with 12 (8.1%) of these cases reporting
recurrence of atrial fibrillation and 20 (13.4%) for any atrial
arrhythmia. Five patients had immediate arrhythmia recurrence with two
patients receiving cardioversion within one week and one month
post-procedure, one recorded event of atrial fibrillation lasting
1-hour, two undocumented episodes of atrial fibrillation reported by the
patient without later recurrence, and atrial tachycardia 24 hours
post-procedure in the context of urinary retention with no further
recurrence. There was no significant differences for any demographic,
procedural, or complication data between recurrent and no recurrent
arrhythmia cases.