scholarly journals Longstanding Persistent Atrial Fibrillation Ablation: How Do You Perform It?

2020 ◽  
Vol 33 (2) ◽  
pp. 89-95
Author(s):  
Carola Gianni ◽  
Andrea Natale ◽  
Amin Al-Ahmad
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Ablation Procedure ◽  
First Time

Longstanding-persistent atrial fibrillation is one of the most challenging arrhythmias to treat. While radiofrequency catheter ablation is highly effective in paroxysmal atrial fibrillation, pulmonary vein antral isolation (including posterior wall isolation) alone is not enough for nonparoxysmal atrial fibrillation, other targets should be sought in this population. In this case report, we will describe our approach in a typical patient presenting for a first-time ablation procedure for longstanding persistent atrial fibrillation.

scholarly journals 471 Arrhythmia-free survival in early-persistent atrial fibrillation patients undergoing radiofrequency catheter ablation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Michele Magnocavallo ◽  
Domenico Giovanni Della Rocca ◽  
Carlo Lavalle ◽  
Cristina Chimenti ◽  
Gianni Carola ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Success Rate ◽  
Pulmonary Vein ◽  
Survival Data ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Free Survival ◽  
One Year

Abstract Aims Despite advances in success rate of paroxysmal atrial fibrillation (PAF) ablation, outcomes of radiofrequency catheter ablation (RFCA) in patients with persistent AF are highly variable. Early persistent AF (EPsAF) is defined as AF that is sustained beyond 7 days but is less than 3 months in duration. Arrhythmia-free survival data after RFCA in this specific population are still limited. We sought to report the outcomes of RFCA in the subgroup of patients with EPsAF, compared to those with PAF and with ‘late’ persistent AF (LPsAF) lasting between 3 and 12 months. Methods and results Data from 1143 consecutive AF patients receiving their first RFCA were prospectively collected. Patients with EPsAF (n = 190) were compared with PAF (n = 531) and LPsAF (n = 422) patients. All patients received pulmonary vein antrum isolation + posterior wall and sustained non-pulmonary vein (PV) trigger ablation. Non-sustained non-PV triggers were ablated based on operator discretion. Non-PV triggers were defined as sites of firing leading to sustained (>30 s) or non-sustained arrhythmias (<30 s, including premature atrial contractions ≥10 beats/min) with earliest activation outside the PVs. Mean age of the population was 64 ± 11 years. Female patients were more in PAF group (39%) compared to EPsAF (26%) and LPsAF (28%) (P < 0.001). There was no difference in other clinical characteristics among populations. Non-PV triggers were detected more in EPsAF [127 (66.8%)], and LPsAF [296 (70.1%)] patients compared to PAF [185 (34.8%)] (P < 0.001).One-year arrhythmia-free survival rate after a single procedure was 75.0% (398), 74.2% (141), and 64.5% (272) in PAF, EPsAF, and LPsAF, respectively. Success rate was significantly higher in PAF {[HR: 0.67 (0.53, 0.84), P = 0.001] and EPsAF [HR: 0.67 (0.49, 0.93)], P = 0.015} compared to LPsAF. Conclusions In patients with EPsAF, RFCA may result in significantly better freedom from atrial arrhythmias, compared to LPsAF. In this cohort, ablation might be reasonable as first line approach to improve outcomes and prevent AF progression.

Catheter ablation for lone atrial fibrillation in individuals aged under 35 years

2019 ◽  
Vol 29 (5) ◽  
pp. 643-648 ◽  
Author(s):  
Jindong Chen ◽  
Hao Wang ◽  
Mengmeng Zhou ◽  
Liang Zhao
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Radiofrequency Catheter Ablation ◽  
Atrial Tachyarrhythmia ◽  
Lone Atrial Fibrillation ◽  
Significant Independent Predictor ◽  
Atrial Size

AbstractBackground:To assess the effectiveness of radiofrequency catheter ablation for lone atrial fibrillation in young adults.Methods:This single-centre, retrospective, observational study enrolled 75 consecutive patients (86.7% men) under 35 (median, 30) years old with lone atrial fibrillation (68% paroxysmal, 26.7% persistent, and 5.3% long-standing persistent) without other cardiopulmonary diseases who underwent catheter ablation between April 2009 and May 2017. Procedural endpoints were circumferential pulmonary vein ablation for atrial fibrillation with pulmonary vein trigger, and target ablation or bidirectional block of lines and disappearance of complex fractionated atrial electrograms for atrial fibrillation with clear and unclear non-pulmonary vein triggers, respectively.Results:Main study outcome was rate of survival free from atrial tachyarrhythmia recurrence, which at median 61 (range, 5–102) months follow-up was 62.7% (64.7 and 58.3% for paroxysmal and non-paroxysmal atrial fibrillation, respectively) after single ablation, and 69.3% (68.6 and 70.8% for paroxysmal and non-paroxysmal atrial fibrillation, respectively) after mean 1.2 ablations (two and three ablations in 11 and 2 patients, respectively). In multivariate analysis, non-pulmonary vein trigger was a significant independent predictor of recurrent atrial tachyarrhythmia (OR, 10.60 [95%CI, 2.25–49.96]; p = 0.003). There were no major periprocedural adverse events.Conclusions:In patients under 35 years old with lone atrial fibrillation, radiofrequency catheter ablation appeared effective particularly for atrial fibrillation with pulmonary vein trigger and regardless of left atrial size or atrial fibrillation duration or type. Atrial tachyarrhythmia recurrence after multiple ablations warrants further study.

scholarly journals Limited Ablation for Persistent Atrial Fibrillation Using Preprocedure Reverse Remodelling

2014 ◽  
Vol 3 (2) ◽  
pp. 101 ◽  
Author(s):  
David Slotwiner ◽  
Jonathan Steinberg ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Effective Treatment ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Tissue Remodelling ◽  
Effective Treatment Option ◽  
Atrial Tissue ◽  
Reverse Remodelling

Pulmonary vein isolation (PVI) has been demonstrated to be a highly effective treatment option for patients with paroxysmal atrial fibrillation (AF), but less effective for patients with persistent AF. The lower efficacy of PVI alone has been attributed to adverse atrial electrical and structural remodelling in the setting of AF. Strategies to improve efficacy of catheter ablation for persistent AF alter these pathophysiological characteristics of atrial tissue remodelling. Here we will review the physiology of atrial electrical remodelling observed during AF and evidence that it is reversible. Further, we will explore its uses to reduce the amount of atrial tissue that needs to be ablated to successfully treat patients with persistent AF.

scholarly journals Fractionated Mapping-Guided Ablation Strategy in Patients with Long-Standing Persistent Atrial Fibrillation: a Case Series

2020 ◽  
Vol 33 (2) ◽  
pp. 82-88
Author(s):  
Tolga Aksu ◽  
Tumer Erdem Guler ◽  
Serdar Bozyel ◽  
Kivanc Yalin
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Case Series ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Mitral Isthmus

Although pulmonary vein isolation (PVI) remains the cornerstone of ablation for paroxysmal atrial fibrillation (AF), optimal ablation strategy for long-standing persistent AF (LSPAF) remains unclear. This article presents two patients with LSPAF in whom acute AF termination was achieved during ablation by using fractionated-guided extended PVI, posterior wall isolation, and mitral isthmus.

Abstract 16499: Hybrid Cryoballoon Pulmonary Vein Isolation and Radiofrequency Posterior Wall Isolation for Persistent Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Heajung L Nguyen ◽  
Carlos Macias ◽  
Houman Khakpour ◽  
Jason S Bradfield ◽  
Kalyanam Shivkumar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Energy Source ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Significant Difference ◽  
Hybrid Ablation

Introduction: Catheter ablation of persistent atrial fibrillation (AF) is associated with less successful outcomes compared to paroxysmal AF. The optimal ablation strategy for persistent AF is not well established. We report our center’s experience utilizing a hybrid ablation approach of cryoballoon (CB) pulmonary vein isolation (PVI) followed by radiofrequency (RF) left atrial posterior wall isolation (LAPWI). Methods: 134 patients with persistent AF who underwent catheter ablation between 2016 and 2019 at our center were retrospectively reviewed. Patients with congenital heart disease or prior left atrial ablation or surgery were excluded. Hybrid ablation (n=62) consisted of CB PVI followed by RF roof and floor lines resulting in LAPWI. The control group (n=72) had PVI ±LAPWI with either CB (n=38) or RF (n=34). Outcomes were monitored with office visits and 7-day Holter monitors at 3, 6, 12, and 24 months post-ablation. The primary endpoint was freedom from any documented atrial tachyarrhythmia over 30 seconds. Results: Concomitant atrial flutter ablation was performed in 19/62 (31%) and 5/72 (7%) of hybrid and control cases, respectively. There was no significant difference in procedure time, however fluoroscopy time was shorter with hybrid ablation compared to control (p<.01). 18-month freedom from atrial tachyarrhythmias was 70.4% with hybrid ablation and 51.6% with PVI±LAPWI with a single energy source (p=.048). Among those with recurrence, mean AF burden was significantly lower with hybrid ablation (7%) than with a single-energy approach (60%). Conclusion: In this single center experience with multiple operators, hybrid CB-RF PVI and LAPWI reduced AF recurrence (incidence and burden) compared to PVI±LAPWI with a single energy source.

Abstract 16416: Non PV Triggers Ablation Improves the Success Rate of Catheter Ablation of Persistent Atrial Fibrillation After a Single Procedure: Results From a Prospective Multicenter Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Luigi Di Biase ◽  
Chintan Trivedi ◽  
Prasant Mohanty ◽  
Sanghamitra Mohanty ◽  
Rong Bai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Success Rate ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Single Procedure ◽  
Group I ◽  
Group Ii

Introduction: Catheter ablation of persistent atrial fibrillation (AF) has a lower success rate when compared to paroxysmal AF patients. Whether in persistent AF patients ablation of the pulmonary vein antrum and posterior wall is sufficient to achieve long term freedom from AF is debated in the literature. We investigated if the ablation on non pv triggers from first procedure in addition to PV and posterior wall(PW) isolation could improve the procedural success rate. Methods: 622 consecutive pts with persistent AF undergoing the first AF ablation were analysed and divided into 2 groups according to their ablation strategy. In group 1, pulmonary vein plus posterior wall ablation was performed (n=203) while in group 2 pulmonary veins plus posterior wall plus sustained and non sustained non pv triggers as disclosed by isoproterenol challenge were ablated. (n=419). All patients were followed up with intensive holter and event monitoring. Results: Clinical baseline characteristics were not statistically different between groups. After 17.8 ± 8.8 months follow-up, 118(58.1%) Group I and 283 (67.5%) Group II patients were free from any atrial tachyarrhythmias (log-rank p= 0.027). After adjusting for age, gender and clinically relevant variables, PVI and PW ablation alone was associated with significantly high recurrence. (Hazard ratio: 1.4, 95% Confidence Interval = 1.1– 1.8, p=0.02). Further, Group I patients undergoing redo procedure after a failed ablation had more NPV trigger Group II (80% vs 60%, p = 0.002, respectively, figure), while the number of patients with PV reconnection were similar between groups (65% vs. 64%, p=1.0). Conclusions: The results of our study shows that after a single procedure the ablation of non PV triggers, improves the long-term success rate in patients with persistent AF.

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