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Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation
Author(s) -
Yamaguchi Junji,
Takahashi Yoshihide,
Yamamoto Tasuku,
Amemiya Miki,
Sekigawa Masahiro,
Shirai Yasuhiro,
Tao Susumu,
Hayashi Tatsuya,
Yagishita Atsuhiko,
Takigawa Masateru,
Goya Masahiko,
Sasano Tetsuo
Publication year - 2020
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.14673
Subject(s) - medicine , atrial fibrillation , pulmonary vein , atrial tachycardia , cardiology , ablation , catheter ablation , tachycardia
Background Recent studies have shown the improvement in long‐term effectiveness with standardized pulmonary vein isolation (PVI) aimed at creating durable and contiguous lesions with VISITAG SURPOINT (VS) in paroxysmal atrial fibrillation (PAF). Objective We aimed to assess efficacy of PVI alone strategy using VS in non‐PAF patients and evaluate factors associated with corresponding clinical outcomes. Methods Consecutive patients who underwent PVI for persistent/long‐standing persistent AF between May 2017 to July 2019 were studied retrospectively. PVI was performed with 30–50 W guided by VS (posterior target: 400–500, anterior target: 500). Left atrial voltage maps were created during atrial pacing after PVI. Results A total of 140 patients (119 males, age 62 ± 10 years, long‐standing persistent AF: 35) were included and followed for median of 454 days. No adverse events were reported in any patients during periprocedural and follow‐up period of up to 28 months. Kaplan–Meier analysis estimated that freedom from atrial tachycardia or AF (AT/AF) without antiarrhythmics at 1‐year was 70%. Radiofrequency delivery with higher power was associated with increased first‐pass isolation rate, but not with freedom from AT/AF. In multivariate analysis, long‐standing persistent AF and % low‐voltage zone (%LVZ) were independent predictors of clinical outcome. The best cut‐off value of %LVZ for predicting AT/AF recurrence was 3.24%. Freedom from AT/AF was 88% in patients with persistent AF and %LVZ < 3.24%, while 27% in those with long‐standing persistent AF and %LVZ ≥ 3.24%. Conclusions PVI alone using VS was associated with excellent 1‐year success in patients with persistent AF and %LVZ < 3.24%, but was insufficient in those with long‐standing persistent AF and/or %LVZ ≥ 3.24%.