Open AccessPulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation
Author(s) -
Junarta Joey,
Dikdan Sean J.,
Upadhyay Naman,
Molin Andrea,
Bodempudi Sairamya,
Warner Eric,
Joffe Daniel,
Pang Zachary,
Frisch Daniel R.
Publication year - 2022
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12727
Subject(s) - medicine , pulmonary vein , ablation , atrial fibrillation , sinus rhythm , cardiology , catheter ablation , ejection fraction , catheter , anesthesia , surgery , heart failure
Background The value of additional ablation beyond pulmonary vein isolation for atrial fibrillation (AF) ablation is unclear, especially for persistent AF. It is uncertain whether substrate modification with additional extensive ablation improves outcomes. We reviewed our experience to determine whether pulmonary vein isolation with additional extensive ablation (PVIEA) improves outcomes compared to pulmonary vein isolation alone (PVIA) for AF ablation. Methods Consecutive cases of patients with PVIA versus PVIEA were compared between September 9, 2013 and December 12, 2020. Procedural data collected include radiofrequency ablation delivery time (RADT) and arrhythmia inducibility. Clinical data collected include sinus rhythm maintenance post‐procedure. Results A total of 235 patients were studied (67 PVIA and 168 PVIEA). RADT was shorter when comparing ablation with PVIA versus PVIEA (32 vs. 40 min; p = .04). More arrhythmias were inducible with PVIEA ( p < .01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log‐rank test p = .75), after 3 or 12 months between groups overall, and when stratified by AF type (paroxysmal and persistent), left atrial volume, CHA 2 DS 2 ‐VASc score, left ventricular ejection fraction, or catheter ablation setting (high‐power short‐duration, standard‐power standard‐duration, temperature‐controlled non‐contact‐force). Conclusion AF ablation with PVIA or PVIEA produces similar sinus rhythm maintenance overall and when stratified by catheter setting and AF type. PVIA reduced procedure times and less arrhythmias were inducible post‐ablation.