TY - JOUR
T1 - Proven isolation of the pulmonary vein antrum with or without left atrial posterior wall isolation in patients with persistent atrial fibrillation
AU - Bai, Rong
AU - Di Biase, Luigi
AU - Mohanty, Prasant
AU - Trivedi, Chintan
AU - Dello Russo, Antonio
AU - Themistoclakis, Sakis
AU - Casella, Michela
AU - Santarelli, Pietro
AU - Fassini, Gaetano
AU - Santangeli, Pasquale
AU - Mohanty, Sanghamitra
AU - Rossillo, Antonio
AU - Pelargonio, Gemma
AU - Horton, Rodney
AU - Sanchez, Javier
AU - Gallinghouse, Joseph
AU - Burkhardt, J. David
AU - Ma, Chang Sheng
AU - Tondo, Claudio
AU - Natale, Andrea
N1 - Funding Information:
Dr. Bai was supported by the National Natural Science Foundation of China (NSFC-81370290) and the Program of Beijing High-caliber Talent from Overseas (BHTO201410007). Dr. Di Biase is a consultant for Biosense Webster, St Jude Medical, and Stereotaxis and reports having received speaker honoraria or travel fees from Biotronik, AtriCure, Medtronic, Biotronik, Boston Scientific, and Epi EP. Dr. Natale reports having received speaker honoraria from Boston Scientific, Biosense Webster, Medtronic, and St. Jude. All other authors have reported that they have no conflicts to disclose. Preliminary results of this study were presented as an abstract by Dr. Bai at the 33rd Annual Scientific Sessions of the Heart Rhythm Society, May 9–12, 2012, Boston, MA.
Publisher Copyright:
© 2016 Heart Rhythm Society.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background It is unclear whether isolation of the left atrial posterior wall (LAPW) offers additional benefits over pulmonary vein antrum isolation (PVAI) alone in patients with persistent atrial fibrillation (AF). Objective We sought to determine the impact of PVAI and LAPW isolation (PVAI+LAPW) versus PVAI alone on the outcome of ablation of persistent AF. Methods During the first procedure, PVAI was performed in 20 patients (group 1), whereas in 32 patients (group 2), PVAI was extended to the left atrial (LA) septum and coronary sinus (CS), and isolation of the LAPW was targeted (ePVAI+LAPW). Isolation of the superior vena cava was achieved in both groups. All patients, regardless of arrhythmia recurrence, underwent a second procedure 3 months after the first procedure. In patients with reconnection of pulmonary veins or LAPW, reisolation was performed, and a third procedure was performed 3 months later to verify isolation. Patients entered follow-up only after PVAI (group 1) or PVAI+LAPW (group 2) isolation was proven. Results At the 1-, 2-, and 3-year follow-up examinations, the rates of freedom from atrial tachyarrhythmia without use of an antiarrhythmic drug were 20%, 15%, and 10% in group 1 and 65%, 50%, and 40% in group 2, respectively (log-rank P <.001). The median recurrence-free survival time was 8.5 months (interquartile range 6.5-11.0) in group 1 and 28.0 months (interquartile range 8.5-32.0) in group 2. Conclusion Proven isolation of the LAPW provides additional benefits over PVAI alone in the treatment of persistent AF and improves procedural outcome at follow-up. However, the ablation strategy of ePVAI+LAPW is still associated with a significant high incidence of very late recurrence of atrial tachyarrhythmia. Clinical Trial Registration "Outcome of Atrial Fibrillation Ablation After Permanent Pulmonary Vein Antrum Isolation With or Without Proven Left Atrial Posterior Wall Isolation" (LIBERATION). ClinicalTrials.gov Identifier: NCT01660100.
AB - Background It is unclear whether isolation of the left atrial posterior wall (LAPW) offers additional benefits over pulmonary vein antrum isolation (PVAI) alone in patients with persistent atrial fibrillation (AF). Objective We sought to determine the impact of PVAI and LAPW isolation (PVAI+LAPW) versus PVAI alone on the outcome of ablation of persistent AF. Methods During the first procedure, PVAI was performed in 20 patients (group 1), whereas in 32 patients (group 2), PVAI was extended to the left atrial (LA) septum and coronary sinus (CS), and isolation of the LAPW was targeted (ePVAI+LAPW). Isolation of the superior vena cava was achieved in both groups. All patients, regardless of arrhythmia recurrence, underwent a second procedure 3 months after the first procedure. In patients with reconnection of pulmonary veins or LAPW, reisolation was performed, and a third procedure was performed 3 months later to verify isolation. Patients entered follow-up only after PVAI (group 1) or PVAI+LAPW (group 2) isolation was proven. Results At the 1-, 2-, and 3-year follow-up examinations, the rates of freedom from atrial tachyarrhythmia without use of an antiarrhythmic drug were 20%, 15%, and 10% in group 1 and 65%, 50%, and 40% in group 2, respectively (log-rank P <.001). The median recurrence-free survival time was 8.5 months (interquartile range 6.5-11.0) in group 1 and 28.0 months (interquartile range 8.5-32.0) in group 2. Conclusion Proven isolation of the LAPW provides additional benefits over PVAI alone in the treatment of persistent AF and improves procedural outcome at follow-up. However, the ablation strategy of ePVAI+LAPW is still associated with a significant high incidence of very late recurrence of atrial tachyarrhythmia. Clinical Trial Registration "Outcome of Atrial Fibrillation Ablation After Permanent Pulmonary Vein Antrum Isolation With or Without Proven Left Atrial Posterior Wall Isolation" (LIBERATION). ClinicalTrials.gov Identifier: NCT01660100.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Left atrial posterior wall
KW - Pulmonary vein antrum isolation
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U2 - 10.1016/j.hrthm.2015.08.019
DO - 10.1016/j.hrthm.2015.08.019
M3 - Article
C2 - 26277862
AN - SCOPUS:84955451230
SN - 1547-5271
VL - 13
SP - 132
EP - 140
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -