scholarly journals Virtual In-Silico Modeling Guided Catheter Ablation Predicts Effective Linear Ablation Lesion Set for Longstanding Persistent Atrial Fibrillation: Multicenter Prospective Randomized Study

2017 ◽  
Vol 8 ◽  
Author(s):  
Jaemin Shim ◽  
Minki Hwang ◽  
Jun-Seop Song ◽  
Byounghyun Lim ◽  
Tae-Hoon Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
In Silico ◽  
Randomized Study ◽  
Persistent Atrial Fibrillation ◽  
Prospective Randomized Study ◽  
Ablation Lesion ◽  
In Silico Modeling ◽  
Linear Ablation

Abstract 17457: Does Additional Complex Fractionated Atrial Elecrogram Guided Ablation After Linear Ablation Improve Clinical Outcome of Catheter Ablation for Longstanding Persistent Atrial Fibrillation? A Prospective Randomized Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tae-Hoon Kim ◽  
Jae-Sun Uhm ◽  
Jong-Youn Kim ◽  
Boyoung Joung ◽  
Moon-Hyoung Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcome ◽  
Randomized Study ◽  
Persistent Atrial Fibrillation ◽  
Related Complication ◽  
Recurrence Rates ◽  
Clinical Recurrence ◽  
Linear Ablation ◽  
Improve Clinical Outcome

Introduction: Although long-lasting circumferential pulmonary vein isolation (CPVI) is a corner stone of catheter ablation for atrial fibrillation (AF), it is not clear whether additional linear or complex fractionated atrial electrogram (CFAE)-guided ablations improve clinical outcome in patients with long-standing persistent AF (L-PeAF). Hypothesis: The purposes of this study were to compare CFAE maps before and after linear ablation, and to test whether additional CFAE ablation after linear ablation improves clinical outcome of L-PeAF. Methods: This study enrolled 119 consecutive L-PeAF patients (male 72.8%, 61.7±10.6 years old) who underwent RFCA. After baseline CFAE mapping, we conducted CPVI and linear ablations (posterior box lesion and anterior line). If AF maintained after linear ablation, we mapped CFAE again, and randomly assigned the patients to linear ablation group (Line, n=45) and additional CFAE ablation group (CFAE+Line, n=48). The patients whose AF terminated or changed to AT were excluded from randomization and classified as AF-Stop group (n=26). We compared pre- and post-linear ablation CFAE maps and clinical outcomes of CFAE+Line, Line, and AF-Stop groups. Results: 1. Mean CFAE-cycle length (CL) was significantly prolonged (203.65±40.35 ms to 264.17±39.03 ms, p<0.001) and CFAE area was reduced (15.49±14.95% to 7.95±9.36%, p<0.001) after linear ablation. Post-linear ablation CFAE was mainly located at left atrial (LA) appendage, septum, and posterior inferior LA. 2. There were no differences in total procedure time (p=0.441), ablation time (p=0.144), and procedure-related complication rate (p=0.955) among three groups. 3. During 17.4±10.5 month follow-up period, clinical recurrence rates were 30.4% in CFAE+Line group, 12.8% in Line group, and 16.7% in AF-Stop groups, respectively (Log rank, p=0.138). 4. Additional CFAE ablation after linear ablation did not improve clinical outcome of catheter ablation at all in patients with L-PeAF (HR 2.11, 95% CI 0.91 - 4.89, p=0.082). Conclusions: Linear ablation prolonged CFAE-CL and localized CFAE area in patients with L-PeAF. However, CFAE guided ablation in addition to linear ablation and CPVI did not improve clinical outcome of catheter ablation.

Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: the EARNEST-PVI trial

EP Europace ◽  
2020 ◽  
Author(s):  
Koichi Inoue ◽  
Shungo Hikoso ◽  
Masaharu Masuda ◽  
Yoshio Furukawa ◽  
Akio Hirata ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Primary Endpoint ◽  
Persistent Atrial Fibrillation ◽  
Hazard Ratio ◽  
Complication Rates ◽  
Inferior Margin ◽  
Linear Ablation

Abstract Aims Previous studies could not demonstrate any benefit of more intensive ablation in addition to pulmonary vein isolation (PVI) including complex fractionated atrial electrogram (CFAE) and linear ablation for recurrence in the initial catheter ablation of persistent atrial fibrillation (AF). This study aimed to establish the non-inferiority of PVI alone to PVI plus these additional ablation strategies. Methods and results Patients with persistent AF who underwent an initial catheter ablation (n = 512, long-standing persistent AF; 128 cases) were randomly assigned in a 1:1 ratio to either PVI alone (PVI-alone group) or PVI plus CFAE and/or linear ablation (PVI-plus group). After excluding 15 cases who did not receive procedures, we analysed 249 and 248 patients, respectively. The primary endpoint was recurrence of AF, atrial flutter, and/or atrial tachycardia, and the non-inferior margin was set at a hazard ratio of 1.43. In the PVI-plus group, 85.1% of patients had linear ablation and 15.3% CFAE ablation. After 12 months, freedom from the primary endpoint occurred in 71.3% of patients in the PVI-alone group and in 78.3% in the PVI-plus group [hazard ratio = 1.56 (95% confidence interval: 1.10–2.24), non-inferior P = 0.3062]. The procedure-related complication rates were 2.0% in the PVI-alone group and 3.6% in the PVI-plus group (P = 0.199). Conclusion This randomized trial did not establish the non-inferiority of PVI alone to PVI plus linear ablation or CFAE ablation in patients with persistent AF, but implied that the PVI plus strategy was promising to improve the clinical efficacy (NCT03514693).

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