scholarly journals Optimal Substrate Modification Strategies using Catheter Ablation in Patients with Persistent Atrial Fibrillation: 3‐Year Follow‐up Outcomes

2021 ◽  
Author(s):  
Yu Cheng Hsieh ◽  
Yenn Jiang Lin ◽  
Men Tzung Lo ◽  
Yun Yu Chen ◽  
Chin Yu Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Substrate Modification

scholarly journals Evaluation of proarrythmogenic effects after different techniques of radiofrequency catheter ablation of atrial fibrillation

2015 ◽  
Vol 17 (1) ◽  
pp. 33 ◽  
Author(s):  
S. N. Artemenko ◽  
A. B. Romanov ◽  
V. V. Shabanov ◽  
I. G. Stenin ◽  
D. A. Yelesin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Linear Lesions ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

To assess proarrythmogenic effects after different techniques of radiofrequency catheter ablation, 427 patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation (AF) were examined. The patients were randomized into four groups: antral pulmonary vein isolation (PVI) (Group I), PVI plus roof line and mitral isthmus ablation (Group II), anatomic ablation of ganglionated plexuses (GP) of the left atrium (Group III) and GP plus PVI (Group IV). At the end of follow up (34,43,2 months) the largest number of proarrythmogenic effects was observed in Group II, 24,8% (26 patients). In the remaining groups the percentage of proarrythmogenic effects did not exceed 11%, neither was there any significant difference among Groups I, III and IV. Thus, the creation of additional linear lesions in the left atrium is a predictor of proarrythmogenic effects during follow up.

scholarly journals Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?

2021 ◽  
Author(s):  
Miruna A. Popa ◽  
Marc Kottmaier ◽  
Elena Risse ◽  
Marta Telishevska ◽  
Sarah Lengauer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Transient Phenomenon ◽  
Future Studies

Abstract Background Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. Methods The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. Results ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184–45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003–0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. Conclusion ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies. Graphic abstract

scholarly journals Electrical posterior box isolation in persistent atrial fibrillation changed to paroxysmal atrial fibrillation: a multi-center, prospective, randomized study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.N Pak ◽  
J.B Park ◽  
H.T Yu ◽  
T.H Kim ◽  
J.S Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Recurrence Rate ◽  
Antiarrhythmic Drug ◽  
Persistent Atrial Fibrillation ◽  
Complication Rates ◽  
Clinical Recurrence ◽  
End Point ◽  
Significant Difference

Abstract Background Persistent atrial fibrillation (PeAF) can change to paroxysmal AF (PAF) after antiarrhythmic drug medication and cardioversion. Purpose We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient group. Methods We prospectively randomized 114 patients with PeAF to PAF (male 75%, 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). The primary end-point was AF recurrence after a single procedure, and the secondary end-point was a recurrence pattern, cardioversion rate, and the response to antiarrhythmic drugs (AADs). Results After a mean follow-up of 22.5±9.4 months, the clinical recurrence rate did not significantly differ between the two groups (29.8% vs. 28.1%, p=0.836; log rank p=0.815) The recurrence rate for atrial tachycardias (17.6% vs. 43.8%, p=0.141) was higher in POBI group, but the cardioversion rates (13.5% vs. 8.5%, p=0.434) were not significantly different between two groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% in CPVI group and 59.7% of POBI group (p=0.452). No significant difference was found in the major complication rates between the two groups (5.3% vs. 1.8%, p=0.618), but the total ablation time was significantly longer in the POBI group (4397±842 sec vs. 5337±1517 sec, p&lt;0.001). Conclusion In patients with persistent AF converted to paroxysmal AF by AAD, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation nor influence overall safety. Funding Acknowledgement Type of funding source: None

P962Circumferential pulmonary vein ablation in combination with a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (8.5-year follow-up)

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kettering
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Pulmonary Vein Ablation ◽  
Group A ◽  
Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (&gt; 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.

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