Domenico G Della Rocca1,2, Sanghamitra Mohanty1, Prasant Mohanty1, Chintan Trivedi1, Carola Gianni1, Amin Al-Ahmad1, J David Burkhardt1, G Joseph Gallinghouse1, Patrick Hranitzky1, Javier E Sanchez1, Rodney P Horton1, Luigi Di Biase1,3,4, Andrea Natale1,5,6,7,8. 1. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 2. Department of Cardiovascular Medicine, University of Tor Vergata, Rome, Italy. 3. Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 4. Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. 5. Interventional Electrophysiology, Scripps Clinic, La Jolla, California. 6. Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. 7. Division of Cardiology, Stanford University, Stanford, California. 8. Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, California.
Abstract
INTRODUCTION: Outcome data after catheter ablation (CA) for longstanding persistent atrial fibrillation (LSPAF) lasting less than 2 years are limited and highly variable with different ablation approaches. We aimed to assess the long-term outcomes in patients with LSPAF lasting less than 2 years undergoing extended pulmonary vein antrum isolation (PVAI) versus those with additional non-pulmonary vein (PV) trigger ablation. METHODS AND RESULTS: In this prospective analysis, 381 consecutive patients with LSPAF lasting less than 2 years (age: 64 ± 9 years, 76% male, atrial fibrillation duration: 19 ± 5 months) undergoing their first CA were classified into two groups: Group 1 (n = 104) received PVAI extended to PW plus isolation of superior vena cava (SVC) and Group 2 ( n = 277) received PVAI + PW + SVC + non-PV-trigger ablation. All patients were followed-up for at least 2 years. In case of recurrence, repeat procedure was offered and non-PV triggers were targeted for ablation in all. After a single procedure, 26 (25%) patients in Group 1 and 172 (62.1%) in Group 2 remained arrhythmia-free (P < 0.001). A second procedure was performed in 58 of 78 (74.4%) patients in Group 1 and 77 of 105 (73.3%) patients in Group 2. Non-PV triggers were identified in 52 (89.6%) and 54 (70.1%) patients in Groups 1 and 2, respectively, and targeted for ablation. Overall, 72 (69.2%) patients in Group 1 and 238 (86%) in Group 2 remained arrhythmia-free ( P < 0.001). CONCLUSION: In patients with LSPAF lasting less than 2 years, extended PVAI plus SVC isolation was less likely to achieve long-term sinus rhythm. In the majority of patients, recurrence was due to non-PV triggers and ablation of those resulted in better outcome.
INTRODUCTION: Outcome data after catheter ablation (CA) for longstanding persistent atrial fibrillation (LSPAF) lasting less than 2 years are limited and highly variable with different ablation approaches. We aimed to assess the long-term outcomes in patients with LSPAF lasting less than 2 years undergoing extended pulmonary vein antrum isolation (PVAI) versus those with additional non-pulmonary vein (PV) trigger ablation. METHODS AND RESULTS: In this prospective analysis, 381 consecutive patients with LSPAF lasting less than 2 years (age: 64 ± 9 years, 76% male, atrial fibrillation duration: 19 ± 5 months) undergoing their first CA were classified into two groups: Group 1 (n = 104) received PVAI extended to PW plus isolation of superior vena cava (SVC) and Group 2 ( n = 277) received PVAI + PW + SVC + non-PV-trigger ablation. All patients were followed-up for at least 2 years. In case of recurrence, repeat procedure was offered and non-PV triggers were targeted for ablation in all. After a single procedure, 26 (25%) patients in Group 1 and 172 (62.1%) in Group 2 remained arrhythmia-free (P < 0.001). A second procedure was performed in 58 of 78 (74.4%) patients in Group 1 and 77 of 105 (73.3%) patients in Group 2. Non-PV triggers were identified in 52 (89.6%) and 54 (70.1%) patients in Groups 1 and 2, respectively, and targeted for ablation. Overall, 72 (69.2%) patients in Group 1 and 238 (86%) in Group 2 remained arrhythmia-free ( P < 0.001). CONCLUSION: In patients with LSPAF lasting less than 2 years, extended PVAI plus SVC isolation was less likely to achieve long-term sinus rhythm. In the majority of patients, recurrence was due to non-PV triggers and ablation of those resulted in better outcome.
Authors: Michele Magnocavallo; Giampaolo Vetta; Domenico G Della Rocca; Carola Gianni; Sanghamitra Mohanty; Mohamed Bassiouny; Luca Di Lullo; Armando Del Prete; Donatello Cirone; Carlo Lavalle; Cristina Chimenti; Amin Al-Ahmad; J David Burkhardt; G Joseph Gallinghouse; Javier E Sanchez; Rodney P Horton; Luigi Di Biase; Andrea Natale Journal: Card Electrophysiol Clin Date: 2022-01-22
Authors: Michele Magnocavallo; Antonio Parlavecchio; Giampaolo Vetta; Carola Gianni; Marco Polselli; Francesco De Vuono; Luigi Pannone; Sanghamitra Mohanty; Filippo Maria Cauti; Rodolfo Caminiti; Vincenzo Miraglia; Cinzia Monaco; Gian-Battista Chierchia; Pietro Rossi; Luigi Di Biase; Stefano Bianchi; Carlo de Asmundis; Andrea Natale; Domenico Giovanni Della Rocca Journal: J Clin Med Date: 2022-09-21 Impact factor: 4.964