scholarly journals Long-term outcomes of empirical extra-pulmonary vein linear ablation in patients with persistent atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Hwang ◽  
M Kim ◽  
H Yu ◽  
T Kim ◽  
J Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Clinical Recurrence ◽  
Linear Ablation ◽  
Extra Pulmonary

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants [HI18C0070] and [HI19C0114] from the Korea Health 21 R&D Project, Ministry of Health and Welfare, and a grant [NRF-2020R1A2B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF). Background Although extra-pulmonary vein (PV) left atrial (LA) linear ablation has been performed during catheter ablation (CA) of persistent atrial fibrillation (PeAF), the long-term efficacy and safety of this procedure have not yet been verified. Purpose We investigated whether an anterior line (AL) and posterior box ablation (POBA) in addition to circumferential PV isolation (CPVI) improves the rhythm without worsening the LA function in PeAF patients. Methods We retrospectively compared the additional AL + POBA and CPVI alone groups in 604 patients with PeAF who underwent regular rhythm follow-ups (16.9%; males 79.3%, 58.5 ± 10.7 years of age) after propensity score matching. The primary endpoint was AF recurrence after single procedures and secondary endpoints were the cardioversion rate, response to anti arrhythmic drugs, LA changes, and re-conduction rates of the de-novo ablation lesion set. Results After a mean follow-up of 45.2 ± 33.6 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank p = 0.554) despite longer procedure times in the AL + POBA group (p < 0.001). Atrial tachycardia recurrences (p = 0.001) and the cardioversion rates after ablation (p < 0.001) were higher in the AL + POBA group than CPVI group. AL + POBA was associated with better rhythm outcomes in patients with large anterior LA volume indices (p for interaction 0.037) and low mean LAA(left atrial appendage) voltages (p for interaction 0.019). In repeat procedures, the LA pulse pressure elevation was significant after the AL + POBA. Conclusion In patients with PeAF, an AL + POBA in addition to the CPVI did not improve the rhythm outcomes nor influence the long-term safety, and lead to more extended procedures. Procedure outcomes OverallAL + POBACPVIp-value(n = 604)(n = 302)(n = 302)Procedure time, min190.8 ± 62.6226.9 ± 49.4154.6 ± 52.8<0.001Ablation time, sec5079 ± 19566420 ± 13723738± 1475<0.001Overall complications24 (4.0)13 (4.3)11 (3.6)0.835Early recurrence, n (%)277 (45.9)129 (42.7)148 (49.0)0.142Recurrence type AT, n (% in early recur)77 (27.8)51 (39.5)26 (17.6)<0.001Clinical recurrence within 1-year, n(%)116 (19.2)52 (17.2)65 (21.5)0.256Recurrence type AT, n (% in clinical recur)60 (23.1)46 (30.7)14 (12.7)0.001Cardioversion, n (% in total recur/ % overall)105 (40.4/17.4)74 (49.3/24.5)31 (28.1/10.3)<0.001POBA, posterior box ablation; AL, anterior line; CPVI, circumferential pulmonary vein isolation; AT, atrial tachycardia;Abstract Figure. Long term ablation outcome

Abstract 17461: Clinical Significance of No Pulmonary Vein Potential at Redo-procedure After Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tae-Hoon Kim ◽  
Jae-Sun Uhm ◽  
Boyoung Joung ◽  
Moon-Hyoung Lee ◽  
Hui-Nam Pak
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcome ◽  
Pulmonary Vein ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Female Gender ◽  
Clinical Recurrence ◽  
Kaplan Meier ◽  
Redo Procedure

Introduction: Long-lasting pulmonary vein isolation (PVI) has been shown to be the key determinants for clinical outcome in both patients with paroxysmal and persistent atrial fibrillation (AF). Hypothesis: Although reconnected PV potential (PVP) has been regarded as a main mechanism of AF recurrence after catheter ablation, PVIs are well preserved in some patients at redo-procedure after recurrence. Therefore, we explored the characteristics and clinical outcome of the patients with negative PVP at redo-procedure. Methods: Among 1522 patients with AF who underwent catheter ablation, 143 patients (79.0% male, 56.1±10.0 years old, 65.0% paroxysmal AF) refractory to antiarrhythmic drug underwent redo-procedure. PVP was not shown in 52 patients (PVP- group, 36.4%), but remaining 91 patients showed PVP (PVP+ group, 234/364 (64.3%) of PVs). We mapped triggers with isoproterenol infusion in both groups (after PVI in PVP+ group). Depending on mapping finding, we ablated non-PV foci and added linear ablation or complex fractionated atrial electrogram (CFAE)-guided ablation. Results: 1. PVP- group was independently associated with female gender (OR 2.64 95%CI 1.13~6.21, p=0.026) and later de novo clinical recurrence timing (OR 1.02 95% CI 1.00~1.04, p=0.047). 2. Additional linear ablations were more likely to be performed in PVP- group (92.2% vs. 61.5%, p<0.001), but total ablation time (2411.3±1082.8 vs. 3144.8 ± 1412.5 sec, p=0.003) and procedure time (164.2± 51.4 vs. 144.2±47.1 min, p=0.027) were shorter in PVP- group than in PVP+ group. 3. During 18.4±10.2 months follow-up after redo-ablation, PVP- group showed significantly higher clinical recurrence rate than PVP+ group regardless of redo-ablation strategies (Kaplan Meier, Log Rank p=0.011). The presence of recurred PV connection (PVP+) was independently associated with lower recurrence of AF after repeat ablation (HR 0.46, 95% CI 0.21 - 0.98, p=0.043). Conclusions: AF patients with well-preserved PVI recurred later timing after de novo ablation, but showed poor clinical outcome after redo-ablation procedure, suggesting a potential AF progression.

Results of a new left atrial linear ablation approach compared to antral pulmonary vein isolation for cure of persistent atrial fibrillation

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S191-S192
Author(s):  
Douglas Gibson ◽  
Uma Srivatsa ◽  
Bobbi Hoppe ◽  
Dan Muhtar ◽  
Navinder Sawhney ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
New Left ◽  
Persistent Atrial Fibrillation ◽  
Linear Ablation

scholarly journals Prospective STAR-Guided Ablation in Persistent Atrial Fibrillation Using Sequential Mapping With Multipolar Catheters

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Shohreh Honarbakhsh ◽  
Richard J. Schilling ◽  
Malcolm Finlay ◽  
Emily Keating ◽  
Ross J. Hunter
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Cycle Length ◽  
Atrial Tachycardia ◽  
Antiarrhythmic Drugs ◽  
Persistent Atrial Fibrillation ◽  
Unique Identifier ◽  
Long Term Follow Up

Background: A novel stochastic trajectory analysis of ranked signals (STAR) mapping approach to guide atrial fibrillation (AF) ablation using basket catheters recently showed high rates of AF termination and subsequent freedom from AF. Methods: This study aimed to determine whether STAR mapping using sequential recordings from conventional pulmonary vein mapping catheters could achieve similar results. Patients with persistent AF<2 years were included. Following pulmonary vein isolation AF drivers (AFDs) were identified on sequential STAR maps created with PentaRay, IntellaMap Orion, or Advisor HD Grid catheters. Patients had a minimum of 10 multipolar recordings of 30 seconds each. These were processed in real-time and AFDs were targeted with ablation. An ablation response was defined as AF termination or cycle length slowing ≥30 ms. Results: Thirty patients were included (62.4±7.8 years old, AF duration 14.1±4.3 months) of which 3 had AF terminated on pulmonary vein isolation, leaving 27 patients that underwent STAR-guided AFD ablation. Eighty-three potential AFDs were identified (3.1±1.1 per patient) of which 70 were targeted with ablation (2.6±1.2 per patient). An ablation response was seen at 54 AFDs (77.1% of AFDs; 21 AF termination and 33 cycle length slowing) and occurred in all 27 patients. No complications occurred. At 17.3±10.1 months, 22 out of 27 (81.5%) patients undergoing STAR-guided ablation were free from AF/atrial tachycardia off antiarrhythmic drugs. Conclusions: STAR-guided AFD ablation through sequential mapping with a multipolar catheter effectively achieved an ablation response in all patients. AF terminated in a majority of patients, with a high freedom from AF/atrial tachycardia off antiarrhythmic drugs at long-term follow-up. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02950844.

Abstract 15311: Drivers Associated With Dense Fibrotic Regions Are Critical Targets in Extra-Pulmonary Vein Ablation in Persistent Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Megan M Subr ◽  
Uma Mylavarapu ◽  
Lisa Hoenie ◽  
Allison Wilson ◽  
Katelynn M Helfrich ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Free Survival ◽  
Basket Catheter ◽  
Extra Pulmonary ◽  
Right Atria ◽  
Lge Cmr

Background: Multielectrode mapping (MEM) of extra-pulmonary vein (PV) targeted ablation of persistent atrial fibrillation (PsAF) drivers suffers from false positives. Early studies suggest that true AF drivers are anchored to arrhythmogenic fibrosis, which can be visualized with late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) to distinguish them from false positive drivers on MEM. Hypothesis: Driver regions integral to AF correlate with high atrial fibrosis; therefore, ablation of MEM-defined drivers within fibrotic regions may lead to better outcomes than MEM-defined drivers outside fibrosis. Methods: Pre-ablation, 10 PsAF patients (Pts) (70% male; 65±11 y/o) underwent LGE-CMR at 3T (0.625x0.625x1.25mm 3 , 0.2mmol/kg gadolinium). During ablation, MEM (64-electrode basket catheter) was used to identify Pt-specific extra-PV drivers. Retrospectively, both left (LA) and right atria (RA) were analyzed with atria-specific fibrosis masks (voxels exceeding an intensity of 3-3.5 standard deviations above the mean intensity of nonfibrotic atrial wall). Ablated drivers were classified as fibrotic driver (dense or patchy) or nonfibrotic driver by LGE-CMR and MEM correlation. Results: 30 drivers were ablated in 10 PsAF Pts (2±1 LA drivers/Pt, 1±1 RA drivers/Pt) and were classified if anchored to dense (n=16, 45.4±31.7%, 2.6±1.8cm 2 ), patchy (n=11, 8.9±13.5%, 2.0±2.5cm 2 ), or no (n=3, 2.3±2.0%) fibrosis. At follow-up (13±7 mos), 7/10 Pts remained free from AF and atrial flutter, all of whom had at least one dense fibrosis driver ablated and all but 1 Pt had ablations limited to fibrotic drivers. 2/3 patients with failure at follow-up had a nonfibrotic driver ablated. Conclusion: Our results suggest that limiting ablation of AF drivers to those anchored to dense fibrotic substrate may improve long-term AF-free survival. Identification of Pt-specific fibrotic substrate by LGE-CMR may help specificity of MEM ablation targets for successful PsAF treatment.

Long-term outcomes of cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation

EP Europace ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. 1653-1662 ◽  
Author(s):  
Hikmet Yorgun ◽  
Uğur Canpolat ◽  
Metin Okşul ◽  
Yusuf Ziya Şener ◽  
Ahmet Hakan Ateş ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Persistent Atrial Fibrillation ◽  
Atrial Appendage ◽  
Left Atrial Appendage Isolation

Abstract Aims Pulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF. Methods and results We compared 144 persistent AF patients (59 ± 10 years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 ± 6 years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG’s, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a mean of 30.5 ± 5.6 months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P = 0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P = 0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81–5.03; P < 0.001). Conclusions Our findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.

scholarly journals Association of ZFHX3 Genetic Polymorphisms and Extra-Pulmonary Vein Triggers in Patients With Atrial Fibrillation Who Underwent Catheter Ablation

2022 ◽  
Vol 12 ◽  
Author(s):  
Inseok Hwang ◽  
Oh-Seok Kwon ◽  
Myunghee Hong ◽  
Song-Yi Yang ◽  
Je-Wook Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Genetic Polymorphisms ◽  
Genome Wide Association Study ◽  
De Novo ◽  
Polygenic Risk Score ◽  
Clinical Recurrence ◽  
Extra Pulmonary ◽  
Af Recurrence

Background: The ZFHX3 gene (16q22) is the second most highly associated gene with atrial fibrillation (AF) and is related to inflammation and fibrosis. We hypothesized that ZFHX3 is associated with extra-pulmonary vein (PV) triggers, left atrial (LA) structural remodeling, and poor rhythm outcomes of AF catheter ablation (AFCA).Methods: We included 1,782 patients who underwent a de novo AFCA (73.5% male, 59.4 ± 10.8 years old, 65.9% paroxysmal AF) and genome-wide association study and divided them into discovery (n = 891) and replication cohorts (n = 891). All included patients underwent isoproterenol provocation tests and LA voltage mapping. We analyzed the ZFHX3, extra-PV trigger-related factors, and rhythm outcomes.Result: Among 14 single-nucleotide polymorphisms (SNPs) of ZFHX3, rs13336412, rs61208973, rs2106259, rs12927436, and rs1858801 were associated with extra-PV triggers. In the overall patient group, extra-PV triggers were independently associated with the ZFHX3 polygenic risk score (PRS) (OR 1.65 [1.22–2.22], p = 0.001, model 1) and a low LA voltage (OR 0.74 [0.56–0.97], p = 0.029, model 2). During 49.9 ± 40.3 months of follow-up, clinical recurrence of AF was significantly higher in patients with extra-PV triggers (Log-rank p &lt; 0.001, HR 1.89 [1.49–2.39], p &lt; 0.001, model 1), large LA dimensions (Log-rank p &lt; 0.001, HR 1.03 [1.01–1.05], p = 0.002, model 2), and low LA voltages (Log-rank p &lt; 0.001, HR 0.73 [0.61–0.86], p &lt; 0.001, model 2) but not the ZFHX3 PRS (Log-rank p = 0.819).Conclusion: The extra-PV triggers had significant associations with both ZFHX3 genetic polymorphisms and acquired LA remodeling. Although extra-PV triggers were an independent predictor of AF recurrence after AFCA, the studied AF risk SNPs intronic in ZFHX3 were not associated with AF recurrence.

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