Kartläggning av patienter remitterade för lungvensisolering från medicinklinikerna i Region Halland

Abstract

Abstract Degree Project thesis, Programme in Medicine, Survey of patients referred to pulmonary vein isolation for symptomatic atrial fibrillation in Region Halland, student Anna Åsare-Dragic, supervisor Docent Johan Engdahl, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, 2015 Background – Atrial fibrillation is the most common clinical arrhythmia with a prevalence increasing with age and cardiovascular disease. Complications are a five-fold risk of stroke, three-fold incidence of heart failure, doubled mortality and frequent hospitalizations. Treatment includes electrocardioversion, drugs for rate and rhythm control and anticoagulation. Additional rhythm-regulating therapy is pulmonary veins isolation. Radiofrequency energy terminates ectopic triggers in the area between the pulmonary veins and the left atrium. Current European and national guidelines recommend catheter ablation as second-line treatment for symptomatic drug-refractory atrial fibrillation, or as first-line therapy in a selected group. Aim – To study patients referred to pulmonary vein isolation by the medical departments in Region Halland during 2013-2014. We aimed at studying patient volumes, adherence to treatment guidelines and short-term outcome including complications. Methods – A retrospective medical record review with clinical and administrative data collected from the medical record system VAS in Region Halland analysed with descriptive statistics in Excel. Results – The study population of 105 patients is predominately cardiovascular healthy with symptomatic, drug-refractory paroxysmal atrial fibrillation. Northern Halland refers a majority of 124 procedures. Arrhythmia Center Stockholm executed 80% of ablations. The waiting time for the operation was fulfilled according to Health Care Guarantee in half of the cases, however with great differences between ablation centres. One complication occurred, a femoral vein hematoma which had to be surgically treated. The adherance to 3-month followup in southern Halland is 35% versus average 70% in northern Halland. Healthcare consumption post-ablation is reduced. The positive short-term outcome is 63%. Conclusion - The clinical application of the method in Region Halland considering the referred patients comply with current national and European guidelines. A significant variation in remittance volume and 3-month follow-up occurs between the northern and southern Halland. Positive short-term outcome are similar to clinical studies.