B-PO05-072 TEMPORARY RESTORATION OF SINUS RHYTHM PRE-ABLATION CAN IMPROVE LONG-TERM ARRHYTHMIA OUTCOMES IN PATIENTS WITH NON-PAROXYSMAL ATRIAL FIBRILLATION UNDERGOING PULMONARY VEIN ISOLATION

IntroductionPulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures.Methods and resultsWe included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74.ConclusionsUsing a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.

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1352: Sinus rhythm in relation to symptoms in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation

European Journal of Cardiovascular Nursing ◽

10.1016/j.ejcnurse.2007.01.049 ◽

2007 ◽

Vol 6 (1_suppl) ◽

pp. 31-32

Author(s):

P.A. Janse ◽

D.A.M.J. Theuns ◽

L.J. Jordaens

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation

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Long-term outcomes of adjunctive complex fractionated electrogram ablation to pulmonary vein isolation as treatment for non-paroxysmal atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-013-9816-4 ◽

2013 ◽

Vol 38 (1) ◽

pp. 19-26 ◽

Cited By ~ 2

Author(s):

Alessandro De Bortoli ◽

Ole-Jørgen Ohm ◽

Per Ivar Hoff ◽

Li-Zhi Sun ◽

Peter Schuster ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Long Term Outcomes ◽

Complex Fractionated Electrogram

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Non-Identification of Arrhythmogenic Site Is the Predictor of Long-Term Prognosis after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation

Journal of Arrhythmia ◽

10.4020/jhrs.27.op07_3 ◽

2011 ◽

Vol 27 (Supplement) ◽

pp. OP07_3

Author(s):

Takashi Uchiyama ◽

Hiroshi Taniguchi ◽

Shigeki Kusa ◽

Kei Takayama ◽

Keiichi Hishikari ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Long Term Prognosis

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Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.117.005019 ◽

2018 ◽

Vol 11 (2) ◽

Cited By ~ 16

Author(s):

Kwang-No Lee ◽

Seung-Young Roh ◽

Yong-Soo Baek ◽

Hee-Soon Park ◽

Jinhee Ahn ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

End Points ◽

Clinical Comparison

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Abstract 2752: Pulmonary Vein Isolation With And Without Additional Ablation Of Complex Fractionated Electrograms In Paroxysmal Atrial Fibrillation: Long-term Results Of A Prospective Randomized Study

Circulation ◽

10.1161/circ.118.suppl_18.s_771-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Isabel Deisenhofer ◽

Tilko Reents ◽

Heidi L Estner ◽

Stephanie Fichtner ◽

Christian von Bary ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Randomized Study ◽

Intention To Treat ◽

Long Term Follow Up ◽

Treat Analysis

Introduction: Segmental pulmonary vein isolation (PVI) leads to elimination of paroxysmal atrial fibrillation (AF) in approximately 75% of patients. Ablation of complex fractionated atrial electrograms (CFAE) is an alternative ablation strategy. In this prospective randomized study the long-term effect of PVI alone is compared to the effect of combined PVI and CFAE ablation in paroxysmal AF. Methods: 98 patients with paroxysmal AF (57±10 years, 74 male) were randomly assigned to PVI (48 patients) or PVI+CFAE ablation (50 patients). Additional CFAE ablation was performed in the PVI+CFAE group if AF was still inducible after PVI. Follow-up results were assessed with repetitive 7 days Holter ECG and clinical evaluation including repeat ablations. Results: Additional CFAE ablation was performed in 30/50 (60%) patients of the PVI+CFAE group with still inducible AF after PVI. In each group, 2 patients were lost to long term follow-up. In the intention-to-treat analysis at 3 months and after 19±8 months, there was no significant difference between both groups (36/48 [75%] and 34/46 [74%] patients in the PVI and 37/50 [73%] and 40/48 [83%] of patients in the PVI+CFAE ablation group in sinus rhythm [p=0.32]). In subgroup analysis, patients actually treated with the combined PVI+CFAE ablation approach had a significantly better long-term success (25/28; 89%) than patients with still inducible AF who underwent PVI only (22/30;73%; p=0.02). In both groups repeat ablations were performed in 31% (PVI group; 15/48 patients) and 35% (PVI+CFAE group; 17/48 patients) (p=n.s). After 9 months, significantly more patients in the PVI+CFAE group experienced sustained regular atrial tachycardia than in the PVI group (6/44 versus 1/39 patients, P=0.02). Conclusion: The combination of PVI and CFAE ablation was equally effective than PVI alone in reaching freedom of AF in the intention-to-treat analysis. During long-term follow-up, patients actually treated with combined PVI+CFAE ablation had a significantly better outcome (89% vs. 73%). However, the rate of ablation-induced regular atrial tachycardias is inreased.

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