Pulmonary vein antral isolation and nonpulmonary vein trigger ablation without additional substrate modification for treating longstanding persistent atrial fibrillation

David Lin, David S. Frankel, Erica S. Zado, Edward Gerstenfeld, Sanjay Dixit, David J. Callans, Michael Riley, Mathew Hutchinson, Fermin Garcia, Rupa Bala, Ralph Verdino, Joshua Cooper, Francis E. Marchlinski

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56 Scopus citations

Abstract

PV Ablation for Persistent Atrial Fibrillation. Introduction: Effectiveness of antral pulmonary vein isolation (PVAI) and ablation of non-PV triggers (non-PVTA) in controlling longstanding persistent atrial fibrillation (AF) has not been reported. We sought to describe clinical outcomes with this ablation strategy in patients (pts) followed for at least 1 year. Methods: Two hundred pts underwent PVAI for longstanding persistent AF and were followed for recurrence. Thirty-three pts with <1-year follow-up and 37 pts with additional RF atrial ablation were excluded, leaving 130 pts for analysis. Results: All 130 pts (108 men, mean LA 4.7 ± 0.6 cm, mean AF duration of 38 ± 44 months) underwent PVAI with entrance/exit block. In addition, 24 pts (15 pts during the initial procedure and 9 additional pts at repeat ablations) had 40 non-PVTA, including 3 with AVNRT. During follow-up, atrial flutter (AFL) was noted in 7 (5%) pts. The AF-free survival after single procedure without antiarrhythmic drugs (AAD) was 38%. Repeat AF or AFL ablation was performed in 37 pts (28%) with PV reconnection uniformly identified (3.7 ± 0.5 veins/pt). During mean follow-up of 41.1 ± 23.8 months (range 12-103 months), 85/130 pts (65%) were in sinus rhythm with 65 pts (50%) off AAD, 20 pts (15%) on AAD. Additionally, 9 pts (7%) have had rare episodes of AF such that 72% of pts have had good long-term clinical outcome. Of the 36 pts with recurrent AF, 20 pts have not had a repeat procedure. Conclusions: PVAI with non-PVTA for longstanding persistent AF provides good long-term AF control in over 70% of patients with infrequent (5%) AFL. AAD therapy and repeat PVAI may be required for this optimal outcome.

Original languageEnglish (US)
Pages (from-to)806-813
Number of pages8
JournalJournal of cardiovascular electrophysiology
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2012

Keywords

  • antiarrhythmic drug
  • atrial fibrillation
  • catheter ablation
  • persistent atrial fibrillation
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Lin, D., Frankel, D. S., Zado, E. S., Gerstenfeld, E., Dixit, S., Callans, D. J., Riley, M., Hutchinson, M., Garcia, F., Bala, R., Verdino, R., Cooper, J., & Marchlinski, F. E. (2012). Pulmonary vein antral isolation and nonpulmonary vein trigger ablation without additional substrate modification for treating longstanding persistent atrial fibrillation. Journal of cardiovascular electrophysiology, 23(8), 806-813. https://doi.org/10.1111/j.1540-8167.2012.02307.x