TY - JOUR
T1 - Pulmonary vein antral isolation and nonpulmonary vein trigger ablation without additional substrate modification for treating longstanding persistent atrial fibrillation
AU - Lin, David
AU - Frankel, David S.
AU - Zado, Erica S.
AU - Gerstenfeld, Edward
AU - Dixit, Sanjay
AU - Callans, David J.
AU - Riley, Michael
AU - Hutchinson, Mathew
AU - Garcia, Fermin
AU - Bala, Rupa
AU - Verdino, Ralph
AU - Cooper, Joshua
AU - Marchlinski, Francis E.
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2012/8
Y1 - 2012/8
N2 - 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.
AB - 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.
KW - antiarrhythmic drug
KW - atrial fibrillation
KW - catheter ablation
KW - persistent atrial fibrillation
KW - pulmonary vein isolation
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U2 - 10.1111/j.1540-8167.2012.02307.x
DO - 10.1111/j.1540-8167.2012.02307.x
M3 - Article
C2 - 22509772
AN - SCOPUS:84866074818
SN - 1045-3873
VL - 23
SP - 806
EP - 813
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 8
ER -