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Comparison of the Efficacy of Empiric Thoracic Vein Isolation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation in Patients Without Structural Heart Disease
Author(s) -
EJIMA KOICHIRO,
HENMI RYUTA,
IWANAMI YUJI,
YAGISHITA DAIGO,
SHODA MORIO,
HAGIWARA NOBUHISA
Publication year - 2017
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/jce.13159
Subject(s) - medicine , atrial fibrillation , pulmonary vein , cardiology , catheter ablation , ejection fraction , ablation , superior vena cava , heart disease , catheter , surgery , heart failure
Empiric Thoracic Vein Isolation Introduction The guidelines suggest that an adjuvant substrate modification in addition to pulmonary vein isolation (PVI) may be needed for persistent atrial fibrillation (PerAF) assuming that catheter ablation is less successful for PerAF than paroxysmal AF (PAF). To revisit the above assumption, we compared the outcome of the same catheter ablation strategy between PAF and PerAF. Methods and Results Two hundred and thirty‐three consecutive patients (mean age 60 ± 10 years, 53 PerAF and 8 long‐lasting PerAF) without structural heart disease underwent catheter ablation of AF by the same strategy using an empiric thoracic vein isolation (a wide circumferential PVI plus empiric superior vena cava isolation) as a major part of the strategy without any adjuvant substrate modification. The duration of AF in the patients with PerAF was 6 ± 4 months. During 25 ± 10 months of follow‐up after single procedures, 71 (30%) patients had atrial tachyarrhythmia recurrences without antiarrhythmic drugs. A Kaplan–Meier analysis of the recurrence‐free survival rate after a single procedure and after repeat procedures revealed no significant difference between the patients with PAF and those with PerAF (log‐rank, P = 0.38 and P = 0.27, respectively). A Cox regression multivariate analysis of the variables including the age, gender, PerAF, body mass index, left ventricular ejection fraction, and left atrial volume index demonstrated that none of the variables were an independent predictor of an atrial tachyarrhythmia recurrence after a single ablation procedure. Conclusion In patients without underlying heart disease, the procedural outcome of an empiric thoracic vein isolation is comparable for PAF and PerAF.