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Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation without Additional Substrate Modification for Treating Longstanding Persistent Atrial Fibrillation
Author(s) -
LIN DAVID,
FRANKEL DAVID S.,
ZADO ERICA S.,
GERSTENFELD EDWARD,
DIXIT SANJAY,
CALLANS DAVID J.,
RILEY MICHAEL,
HUTCHINSON MATHEW,
GARCIA FERMIN,
BALA RUPA,
VERDINO RALPH,
COOPER JOSHUA,
MARCHLINSKI FRANCIS E.
Publication year - 2012
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2012.02307.x
Subject(s) - medicine , pulmonary vein , atrial fibrillation , cardiology , ablation , sinus rhythm , atrial flutter , catheter ablation , antrum , surgery , stomach
PV Ablation for Persistent Atrial Fibrillation. Introduction: Effectiveness of antral pulmonary vein isolation (PVAI) and ablation of non‐PV triggers (non‐PVTA) in controlling longstanding persistent atrial fibrillation (AF) has not been reported. We sought to describe clinical outcomes with this ablation strategy in patients (pts) followed for at least 1 year. Methods: Two hundred pts underwent PVAI for longstanding persistent AF and were followed for recurrence. Thirty‐three pts with <1‐year follow‐up and 37 pts with additional RF atrial ablation were excluded, leaving 130 pts for analysis. Results: All 130 pts (108 men, mean LA 4.7 ± 0.6 cm, mean AF duration of 38 ± 44 months) underwent PVAI with entrance/exit block. In addition, 24 pts (15 pts during the initial procedure and 9 additional pts at repeat ablations) had 40 non‐PVTA, including 3 with AVNRT. During follow‐up, atrial flutter (AFL) was noted in 7 (5%) pts. The AF‐free survival after single procedure without antiarrhythmic drugs (AAD) was 38%. Repeat AF or AFL ablation was performed in 37 pts (28%) with PV reconnection uniformly identified (3.7 ± 0.5 veins/pt). During mean follow‐up of 41.1 ± 23.8 months (range 12–103 months), 85/130 pts (65%) were in sinus rhythm with 65 pts (50%) off AAD, 20 pts (15%) on AAD. Additionally, 9 pts (7%) have had rare episodes of AF such that 72% of pts have had good long‐term clinical outcome. Of the 36 pts with recurrent AF, 20 pts have not had a repeat procedure. Conclusions: PVAI with non‐PVTA for longstanding persistent AF provides good long‐term AF control in over 70% of patients with infrequent (5%) AFL. AAD therapy and repeat PVAI may be required for this optimal outcome. (J Cardiovasc Electrophysiol, Vol. 23, pp. 806‐813, August 2012)