INTRODUCTION: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). METHODS AND RESULTS: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, EI-VOM was firstly performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63(95.5%) and 101(80.8%) patients in group 1 and 2, respectively (p=0.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 min vs 12.59 min, p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p<0.001). In multivariate cox regression, the 'upgraded 2C3L' procedure is associated with a lower recurrence rate (HR 0.27, 95%CI 0.12-0.59). CONCLUSION: Compared with the conventional '2C3L' approach, the 'upgraded 2C3L' approach has higher effectiveness for ablation of PeAF. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
INTRODUCTION: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). METHODS AND RESULTS: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, EI-VOM was firstly performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63(95.5%) and 101(80.8%) patients in group 1 and 2, respectively (p=0.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 min vs 12.59 min, p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p<0.001). In multivariate cox regression, the 'upgraded 2C3L' procedure is associated with a lower recurrence rate (HR 0.27, 95%CI 0.12-0.59). CONCLUSION: Compared with the conventional '2C3L' approach, the 'upgraded 2C3L' approach has higher effectiveness for ablation of PeAF. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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Keywords:
atrial fibrillation; catheter ablation; ethanol infusion; vein of Marshall