Domenico G Della Rocca1, Luigi Di Biase1,2,3,4,5, Sanghamitra Mohanty1, Chintan Trivedi1, Carola Gianni1, Jorge Romero4, Nicola Tarantino4, Michele Magnocavallo6, Mohamed Bassiouny1, Veronica N Natale7, Angel Quintero Mayedo1, Bryan Macdonald1, Carlo Lavalle6, Ghulam Murtaza8, Krishna Akella8, Giovanni B Forleo9, Amin Al-Ahmad1, John David Burkhardt1, Gerald Joseph Gallinghouse1, Javier E Sanchez1, Rodney P Horton1, Juan F Viles-Gonzalez10, Dhanunjaya Lakkireddy9, Andrea Natale1,2,3,11,12,13. 1. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA. 2. Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA. 3. Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA. 4. Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. 5. Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. 6. Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy. 7. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. 8. Cardiovascular Research Institute, Kansas University Hospital, Kansas City, KS, USA. 9. Department of Cardiology, Luigi Sacco Hospital, Milan, Italy. 10. Miami Cardiovascular Institute, Baptist Health, Miami, FL, USA. 11. Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA. 12. Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. 13. Division of Cardiology, Stanford University, Stanford, CA, USA.
Abstract
AIMS: We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF). METHODS AND RESULTS: A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW. A standardized protocol was performed to confirm persistent PVAI and elicit any triggers originating from non-PV sites. All non-PV triggers initiating sustained atrial tachyarrhythmias were ablated. Ablation of non-PV sites triggering non-sustained runs (<30 s) of atrial tachyarrhythmias or promoting frequent premature atrial complexes (≥10/min) was left to operator's discretion. Overall, 1319 (73.2%) patients had documented triggers from non-PV areas. After 17.4 ± 8.5 months of follow-up, the cumulative freedom from atrial tachyarrhythmias among patients without inducible non-PV triggers (n = 484) was 70.2%. Patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (67.9% vs. 39.4%, respectively; P < 0.001). After adjusting for clinically relevant variables, patients in whom non-PV triggers were documented but not ablated had an increased risk of arrhythmia relapse (hazard ratio: 2.39; 95% confidence interval: 2.01-2.83; P < 0.001). CONCLUSION: Pulmonary vein antrum isolation extended to the entire PW might provide acceptable long-term arrhythmia-free survival in PerAF patients without inducible non-PV triggers. In our population of PerAF patients, non-PV triggers could be elicited in ∼70% of PerAF patients and their elimination significantly improved outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF). METHODS AND RESULTS: A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW. A standardized protocol was performed to confirm persistent PVAI and elicit any triggers originating from non-PV sites. All non-PV triggers initiating sustained atrial tachyarrhythmias were ablated. Ablation of non-PV sites triggering non-sustained runs (<30 s) of atrial tachyarrhythmias or promoting frequent premature atrial complexes (≥10/min) was left to operator's discretion. Overall, 1319 (73.2%) patients had documented triggers from non-PV areas. After 17.4 ± 8.5 months of follow-up, the cumulative freedom from atrial tachyarrhythmias among patients without inducible non-PV triggers (n = 484) was 70.2%. Patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (67.9% vs. 39.4%, respectively; P < 0.001). After adjusting for clinically relevant variables, patients in whom non-PV triggers were documented but not ablated had an increased risk of arrhythmia relapse (hazard ratio: 2.39; 95% confidence interval: 2.01-2.83; P < 0.001). CONCLUSION: Pulmonary vein antrum isolation extended to the entire PW might provide acceptable long-term arrhythmia-free survival in PerAF patients without inducible non-PV triggers. In our population of PerAF patients, non-PV triggers could be elicited in ∼70% of PerAF patients and their elimination significantly improved outcomes. Published on behalf of the European Society of Cardiology. All rights reserved.
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