Takanori Yamaguchi1,2, Takeshi Tsuchiya3, Shiro Nakahara4, Akira Fukui3, Yasutsugu Nagamoto3, Kenta Murotani5, Kenichi Eshima6, Naohiko Takahashi7. 1. Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan. takano-yamaguchi@nifty.com. 2. EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan. takano-yamaguchi@nifty.com. 3. EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan. 4. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan. 5. Department of Statistics, Aichi Medical University, Nagakute, Japan. 6. Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan. 7. Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan.
Abstract
BACKGROUND: Low-voltage zones (LVZs) represent fibrotic tissue and are substrates for atrial fibrillation (AF). We hypothesized that LVZ-based substrate modification along with pulmonary vein isolation (PVI) would improve outcomes in persistent AF (PeAF) patients with LVZs, whereas PVI alone would work in patients without LVZs. METHODS AND RESULTS: Voltage mapping of the left atrium (LA) was performed during sinus rhythm in 101 PeAF patients in whom LVZ was defined as an area with bipolar electrograms <0.5 mV. Thirty-nine patients had LVZs and underwent ablation of the entire LVZ area after PVI (LVZabl group). In the remaining 62 patients without LVZs, PVI alone was performed with no further substrate modifications (PVI group). An additional group of 16 consecutive PeAF patients with LVZ did not undergo any substrate modification after PVI and were used as a comparison group (LVZnon-abl group) despite having similar size of LVZs to that in the LVZabl group. After a single session, 28 (72%) patients in the LVZabl group had no recurrence, whereas 49 (79%) patients in the PVI group had no recurrence during 18 ± 7 months of follow-up (log-rank, P = 0.400). In the LVZnon-abl group, only 6 patients (38%) had no recurrence during 32 ± 7 months of follow-up, even after a mean number of sessions of 1.8 (log-rank, P < 0.001, compared with the LVZabl group). CONCLUSIONS: Additional LVZ-based substrate modification after PVI improved the outcome in PeAF patients with LVZs, whereas PVI alone worked in patients without LVZs, even in those with PeAF.
BACKGROUND: Low-voltage zones (LVZs) represent fibrotic tissue and are substrates for atrial fibrillation (AF). We hypothesized that LVZ-based substrate modification along with pulmonary vein isolation (PVI) would improve outcomes in persistent AF (PeAF) patients with LVZs, whereas PVI alone would work in patients without LVZs. METHODS AND RESULTS: Voltage mapping of the left atrium (LA) was performed during sinus rhythm in 101 PeAF patients in whom LVZ was defined as an area with bipolar electrograms <0.5 mV. Thirty-nine patients had LVZs and underwent ablation of the entire LVZ area after PVI (LVZabl group). In the remaining 62 patients without LVZs, PVI alone was performed with no further substrate modifications (PVI group). An additional group of 16 consecutive PeAF patients with LVZ did not undergo any substrate modification after PVI and were used as a comparison group (LVZnon-abl group) despite having similar size of LVZs to that in the LVZabl group. After a single session, 28 (72%) patients in the LVZabl group had no recurrence, whereas 49 (79%) patients in the PVI group had no recurrence during 18 ± 7 months of follow-up (log-rank, P = 0.400). In the LVZnon-abl group, only 6 patients (38%) had no recurrence during 32 ± 7 months of follow-up, even after a mean number of sessions of 1.8 (log-rank, P < 0.001, compared with the LVZabl group). CONCLUSIONS: Additional LVZ-based substrate modification after PVI improved the outcome in PeAF patients with LVZs, whereas PVI alone worked in patients without LVZs, even in those with PeAF.
Authors: Nassir F Marrouche; Oussama Wazni; Christopher McGann; Tom Greene; J Michael Dean; Lilas Dagher; Eugene Kholmovski; Moussa Mansour; Francis Marchlinski; David Wilber; Gerhard Hindricks; Christian Mahnkopf; Darryl Wells; Pierre Jais; Prashanthan Sanders; Johannes Brachmann; Jeroen J Bax; Leonie Morrison-de Boer; Thomas Deneke; Hugh Calkins; Christian Sohns; Nazem Akoum Journal: JAMA Date: 2022-06-21 Impact factor: 157.335
Authors: Mathijs S van Schie; Rohit K Kharbanda; Charlotte A Houck; Eva A H Lanters; Yannick J H J Taverne; Ad J J C Bogers; Natasja M S de Groot Journal: Circ Arrhythm Electrophysiol Date: 2021-06-18