Rong Bai1,2, Luigi DI Biase1,3,4,5, Prasant Mohanty1, Pasquale Santangeli1, Sanghamitra Mohanty1, Agnes Pump1,6, Claude S Elayi7, Yeruva Madhu Reddy8, Giovanni B Forleo9, Richard Hongo10, Salwa Beheiry10, Antonio Dello Russo11, Michela Casella11, Gemma Pelargonio4, Pietro Santarelli4, Rodney Horton1,12, Javier Sanchez1, Joseph Gallinghouse1, J David Burkhardt1, Changsheng Ma2, Dhanunjaya Lakkireddy8, Claudio Tondo11, Andrea Natale1,10,12,13,14. 1. Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA. 2. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 3. Department of Cardiology, University of Foggia, Foggia, Italy. 4. Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. 5. Albert Einstein College of Medicine at Montefiore Hospital, New York, USA. 6. Heart Institute, Faculty of Medicine, University of Pecs, Pecs, Hungary. 7. Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA. 8. Center for Excellence in Atrial Fibrillation and EP Research, Bloch Heart Rhythm Center, Mid-America Cardiology at Kansas University Hospital, Kansas City, Kansas, USA. 9. Division of Cardiology, University Hospital of Tor Vergata, Rome, Italy. 10. Division of Electrophysiology, California Pacific Medical Center, San Francisco, California, USA. 11. Centro Cardiologico Monzino, IRCCS, Milan, Italy. 12. Department of Biomedical Engineering, University of Texas, Austin, Texas, USA. 13. Division of Cardiology, Stanford University, Palo Alto, California, USA. 14. Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.
Abstract
INTRODUCTION: It is unclear whether extended pulmonary vein antrum isolation (PVAI) plus nonpulmonary vein (non-PV) trigger elimination prevents more arrhythmia recurrence than PVAI alone in patients with mechanical mitral valve (MMV) undergoing AF ablation. This study compared the efficacy and long-term outcome of 2 ablation strategies--PVAI alone versus extended PVAI plus non-PV trigger elimination--for the treatment of AF in patients with MMV. METHODS AND RESULTS: One hundred and nine consecutive AF patients with MMV were divided into 2 groups: standard PVAI was performed in group 1 (N = 45); in group 2 (N = 64) PVAI was extended to the LA posterior wall, LA septum, and CS; and all non-PV triggers were eliminated. Patients were followed up for 3 years. At the 12th month, 7 (15.6%) patients in group 1, and 39 (60.9%) patients in group 2 were arrhythmia free (log-rank P < 0.001). Four patients (8.9%; 3 cases of AT and 1 case of AF) from group 1, and 12 patients (18.8%; 9 cases of AT, and 3 cases of AFL) from group 2 experienced very late recurrence. At 36 ± 7 months follow-up, the cumulative recurrence after a single procedure was 42/45 (93.3%) in group 1, and 37/64 (57.8%) in group 2 (log-rank P < 0.001). CONCLUSION: Compared with the standard PVAI alone, a strategy including extended PVAI and non-PV trigger elimination is associated with a higher 12-month and long-term arrhythmia-free survival in patients with MMV undergoing AF ablation. Very late recurrence may occur years after the initial procedure with focal AT as the most common type of recurrent arrhythmia.
INTRODUCTION: It is unclear whether extended pulmonary vein antrum isolation (PVAI) plus nonpulmonary vein (non-PV) trigger elimination prevents more arrhythmia recurrence than PVAI alone in patients with mechanical mitral valve (MMV) undergoing AF ablation. This study compared the efficacy and long-term outcome of 2 ablation strategies--PVAI alone versus extended PVAI plus non-PV trigger elimination--for the treatment of AF in patients with MMV. METHODS AND RESULTS: One hundred and nine consecutive AFpatients with MMV were divided into 2 groups: standard PVAI was performed in group 1 (N = 45); in group 2 (N = 64) PVAI was extended to the LA posterior wall, LA septum, and CS; and all non-PV triggers were eliminated. Patients were followed up for 3 years. At the 12th month, 7 (15.6%) patients in group 1, and 39 (60.9%) patients in group 2 were arrhythmia free (log-rank P < 0.001). Four patients (8.9%; 3 cases of AT and 1 case of AF) from group 1, and 12 patients (18.8%; 9 cases of AT, and 3 cases of AFL) from group 2 experienced very late recurrence. At 36 ± 7 months follow-up, the cumulative recurrence after a single procedure was 42/45 (93.3%) in group 1, and 37/64 (57.8%) in group 2 (log-rank P < 0.001). CONCLUSION: Compared with the standard PVAI alone, a strategy including extended PVAI and non-PV trigger elimination is associated with a higher 12-month and long-term arrhythmia-free survival in patients with MMV undergoing AF ablation. Very late recurrence may occur years after the initial procedure with focal AT as the most common type of recurrent arrhythmia.
Authors: Ki-Hun Kim; Sanghamitra Mohanty; Prasant Mohanty; Chintan Trivedi; Eli Hamilton Morris; Pasquale Santangeli; Rong Bai; Amin Al-Ahmad; John David Burkhardt; Joseph G Gallinghouse; Rodney Horton; Javier E Sanchez; Shane Bailey; Patrick M Hranitzky; Jason Zagrodzky; Soo G Kim; Luigi Di Biase; Andrea Natale Journal: J Interv Card Electrophysiol Date: 2017-03-07 Impact factor: 1.900
Authors: Maciej Kubala; Christian de Chillou; Yohann Bohbot; Patrizio Lancellotti; Maurice Enriquez-Sarano; Christophe Tribouilloy Journal: Front Cardiovasc Med Date: 2022-02-15