Sheldon M Singh1, Andre d'Avila2,3, Young-Hoon Kim4, Arash Aryana5, J Michael Mangrum6, Gregory F Michaud7, Srinivas R Dukkipati2, Conor D Barrett8, E Kevin Heist8, Michael K Parides2, Kevin E Thorpe9, Vivek Y Reddy2. 1. Schulich Heart Program, Sunnybrook Health Science Center, Faculty of Medicine, University of Toronto, Toronto, Canada. 2. Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Instituto de Pesquisa em Arritmia Cardiaca - Hospital Cardiologico, Florianopolis, SC, Brazil. 4. Cardiovascular Division, Korea University Medical Center, Seoul, Republic of Korea. 5. Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA. 6. Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA. 7. Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, MA, USA. 8. Heart Center, Massachusetts General Hospital, Boston, MA, USA. 9. Dalla Lana School of Public Health, Keenan Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Canada.
Abstract
AIMS: Controversy on the optimal ablation strategy for persistent atrial fibrillation (AF) exists with limited work evaluating a strategy of pulmonary vein isolation (PVI) alone when AF terminates during PVI. Thirty-five patients had AF termination during PVI in the Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF; ClinicalTrials.gov number: NCT01014741) study. The objective of the current study is to report the 1-year outcome after PVI alone in this unique patient group. METHODS AND RESULTS: The 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs was reported for the 35 patients in the MAGIC-AF study with persistent AF termination during or upon completion of PVI. Freedom from recurrent atrial arrhythmia was achieved in 60% of patients where AF terminated during PVI. Cavotricuspid isthmus flutter was common when AF terminated to a macro re-entrant flutter during PVI, and responsible for 92% of all flutter circuits with AF termination. CONCLUSIONS: Persistent AF termination during PVI may identify a subgroup of patients who experience a similar long-term clinical outcome with PVI ablation alone when compared with other more extensive persistent AF ablation strategies. Pulmonary vein isolation alone may be an appropriate tactic in this subgroup of persistent AF patients. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Controversy on the optimal ablation strategy for persistent atrial fibrillation (AF) exists with limited work evaluating a strategy of pulmonary vein isolation (PVI) alone when AF terminates during PVI. Thirty-five patients had AF termination during PVI in the Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF; ClinicalTrials.gov number: NCT01014741) study. The objective of the current study is to report the 1-year outcome after PVI alone in this unique patient group. METHODS AND RESULTS: The 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs was reported for the 35 patients in the MAGIC-AF study with persistent AF termination during or upon completion of PVI. Freedom from recurrent atrial arrhythmia was achieved in 60% of patients where AF terminated during PVI. Cavotricuspid isthmus flutter was common when AF terminated to a macro re-entrant flutter during PVI, and responsible for 92% of all flutter circuits with AF termination. CONCLUSIONS: Persistent AF termination during PVI may identify a subgroup of patients who experience a similar long-term clinical outcome with PVI ablation alone when compared with other more extensive persistent AF ablation strategies. Pulmonary vein isolation alone may be an appropriate tactic in this subgroup of persistent AF patients. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Caroline H Roney; Nicholas Child; Bradley Porter; Iain Sim; John Whitaker; Richard H Clayton; Jacob I Laughner; Allan Shuros; Petr Neuzil; Steven E Williams; Reza S Razavi; Mark O'Neill; Christopher A Rinaldi; Peter Taggart; Matt Wright; Jaswinder S Gill; Steven A Niederer Journal: Front Physiol Date: 2021-09-27 Impact factor: 4.755