Amir S Jadidi1, Heiko Lehrmann2, Cornelius Keyl2, Jérémie Sorrel2, Viktor Markstein2, Jan Minners2, Chan-Il Park2, Arnaud Denis2, Pierre Jaïs2, Mélèze Hocini2, Clemens Potocnik2, Juergen Allgeier2, Willibald Hochholzer2, Claudia Herrera-Siklody2, Steve Kim2, Youssef El Omri2, Franz-Josef Neumann2, Reinhold Weber2, Michel Haïssaguerre2, Thomas Arentz2. 1. Arrhythmia Division, Department of Cardiology and Angiology (A.S.J., H.L., J.S., V.M., J.M., C.-I.P., C.P., J.A., W.H., C.H.-S., Y.E.O., F.-J.N., R.W., T.A.) and Department of Anesthesiology (C.K.), University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; Arrhythmia Department, University Hospital Haut-Leveque Bordeaux, Pessac, France (A.D., P.J., M.H., M.H.); and Arrhythmia Division, St. Jude Medical, St. Paul, MN (S.K.). amir.jadidi@universitaets-herzzentrum.de. 2. Arrhythmia Division, Department of Cardiology and Angiology (A.S.J., H.L., J.S., V.M., J.M., C.-I.P., C.P., J.A., W.H., C.H.-S., Y.E.O., F.-J.N., R.W., T.A.) and Department of Anesthesiology (C.K.), University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; Arrhythmia Department, University Hospital Haut-Leveque Bordeaux, Pessac, France (A.D., P.J., M.H., M.H.); and Arrhythmia Division, St. Jude Medical, St. Paul, MN (S.K.).
Abstract
BACKGROUND: Complex-fractionated atrial electrograms and atrial fibrosis are associated with maintenance of persistent atrial fibrillation (AF). We hypothesized that pulmonary vein isolation (PVI) plus ablation of selective atrial low-voltage sites may be more successful than PVI only. METHODS AND RESULTS: A total of 85 consecutive patients with persistent AF underwent high-density atrial voltage mapping, PVI, and ablation at low-voltage areas (LVA < 0.5 mV in AF) associated with electric activity lasting > 70% of AF cycle length on a single electrode (fractionated activity) or multiple electrodes around the circumferential mapping catheter (rotational activity) or discrete rapid local activity (group I). The procedural end point was AF termination. Arrhythmia freedom was compared with a control group (66 patients) undergoing PVI only (group II). PVI alone was performed in 23 of 85 (27%) patients of group I with low amount (< 10% of left atrial surface area) of atrial low voltage. Selective atrial ablation in addition to PVI was performed in 62 patients with termination of AF in 45 (73%) after 11 ± 9 minutes radiofrequency delivery. AF-termination sites colocalized within LVA in 80% and at border zones in 20%. Single-procedural arrhythmia freedom at 13 months median follow-up was achieved in 59 of 85 (69%) patients in group I, which was significantly higher than the matched control group (31/66 [47%], P < 0.001). There was no significant difference in the success rate of patients in group I with a low amount of low voltage undergoing PVI only and patients requiring PVI+selective low-voltage ablation (P = 0.42). CONCLUSIONS: Ablation of sites with distinct activation characteristics within/at borderzones of LVA in addition to PVI is more effective than conventional PVI-only strategy for persistent AF. PVI only seems to be sufficient to treat patients with left atrial low voltage < 10%.
BACKGROUND: Complex-fractionated atrial electrograms and atrial fibrosis are associated with maintenance of persistent atrial fibrillation (AF). We hypothesized that pulmonary vein isolation (PVI) plus ablation of selective atrial low-voltage sites may be more successful than PVI only. METHODS AND RESULTS: A total of 85 consecutive patients with persistent AF underwent high-density atrial voltage mapping, PVI, and ablation at low-voltage areas (LVA < 0.5 mV in AF) associated with electric activity lasting > 70% of AF cycle length on a single electrode (fractionated activity) or multiple electrodes around the circumferential mapping catheter (rotational activity) or discrete rapid local activity (group I). The procedural end point was AF termination. Arrhythmia freedom was compared with a control group (66 patients) undergoing PVI only (group II). PVI alone was performed in 23 of 85 (27%) patients of group I with low amount (< 10% of left atrial surface area) of atrial low voltage. Selective atrial ablation in addition to PVI was performed in 62 patients with termination of AF in 45 (73%) after 11 ± 9 minutes radiofrequency delivery. AF-termination sites colocalized within LVA in 80% and at border zones in 20%. Single-procedural arrhythmia freedom at 13 months median follow-up was achieved in 59 of 85 (69%) patients in group I, which was significantly higher than the matched control group (31/66 [47%], P < 0.001). There was no significant difference in the success rate of patients in group I with a low amount of low voltage undergoing PVI only and patients requiring PVI+selective low-voltage ablation (P = 0.42). CONCLUSIONS: Ablation of sites with distinct activation characteristics within/at borderzones of LVA in addition to PVI is more effective than conventional PVI-only strategy for persistent AF. PVI only seems to be sufficient to treat patients with left atrial low voltage < 10%.
Authors: Steven E Williams; Caroline H Roney; Adam Connolly; Iain Sim; John Whitaker; Daniel O'Hare; Irum Kotadia; Louisa O'Neill; Cesare Corrado; Martin Bishop; Steven A Niederer; Matt Wright; Mark O'Neill; Nick W F Linton Journal: Front Physiol Date: 2021-02-26 Impact factor: 4.566