BACKGROUND: Long-term ablation results for atrial fibrillation (AF) have been disappointing, particularly for non-paroxysmal AF (NPAF). We hypothesize fibrosis in paroxysmal AF (PAF) and NPAF would be reflected in voltage fragmentation and visualized by high density mapping. Targeted ablation of discrete low voltage bridges (LVB) would eliminate endocardial fragmentation and should have a positive effect on long-term sinus rhythm (SR) survival. OBJECTIVE: To assess the efficacy of LVB ablation on SR survival in patients with PAF and NPAF, as well as, determine its impact on P wave duration (PWD) and LA volume (LAV). METHODS: 56 patients (29PAF/26NPAF) had a voltage gradient map (VGM) created, high and low voltage limits were adjusted to image LVB. Ablation was performed until no LVB were observed. Baseline PWD and LAV were obtained and reassessed 6 months' post ablation. Patients were followed for 5 years with intermittent monitors. RESULTS: Termination of AF in NPAF was 88%. PWD normalized in PAF and were normal in NPAF post ablation. LAV decreased significantly in NPAF. At 5 years, SR was observed in 89% of PAF and 67% of NPAF. CONCLUSIONS: 1. LVB ablation terminates AF in NPAF 88%; 2. Both PWD and LAV were improved; 3. Maintenance of SR was observed in 89% and 67% (PAF vs NPAF); 4. The present study demonstrates efficacy of a simplified, individualized, and unified methodology for AF ablation.
BACKGROUND: Long-term ablation results for atrial fibrillation (AF) have been disappointing, particularly for non-paroxysmal AF (NPAF). We hypothesize fibrosis in paroxysmal AF (PAF) and NPAF would be reflected in voltage fragmentation and visualized by high density mapping. Targeted ablation of discrete low voltage bridges (LVB) would eliminate endocardial fragmentation and should have a positive effect on long-term sinus rhythm (SR) survival. OBJECTIVE: To assess the efficacy of LVB ablation on SR survival in patients with PAF and NPAF, as well as, determine its impact on P wave duration (PWD) and LA volume (LAV). METHODS: 56 patients (29PAF/26NPAF) had a voltage gradient map (VGM) created, high and low voltage limits were adjusted to image LVB. Ablation was performed until no LVB were observed. Baseline PWD and LAV were obtained and reassessed 6 months' post ablation. Patients were followed for 5 years with intermittent monitors. RESULTS: Termination of AF in NPAF was 88%. PWD normalized in PAF and were normal in NPAF post ablation. LAV decreased significantly in NPAF. At 5 years, SR was observed in 89% of PAF and 67% of NPAF. CONCLUSIONS: 1. LVB ablation terminates AF in NPAF 88%; 2. Both PWD and LAV were improved; 3. Maintenance of SR was observed in 89% and 67% (PAF vs NPAF); 4. The present study demonstrates efficacy of a simplified, individualized, and unified methodology for AF ablation.
Entities:
Keywords:
Atrial Fibrillation; Catheter Ablation; High Density; Voltage Mapping
Authors: Sascha Rolf; Simon Kircher; Arash Arya; Charlotte Eitel; Philipp Sommer; Sergio Richter; Thomas Gaspar; Andreas Bollmann; David Altmann; Carlos Piedra; Gerhard Hindricks; Christopher Piorkowski Journal: Circ Arrhythm Electrophysiol Date: 2014-08-23
Authors: Daniel Scherr; Paul Khairy; Shinsuke Miyazaki; Valerie Aurillac-Lavignolle; Patrizio Pascale; Stephen B Wilton; Khaled Ramoul; Yuki Komatsu; Laurent Roten; Amir Jadidi; Nick Linton; Michala Pedersen; Matthew Daly; Mark O'Neill; Sebastien Knecht; Rukshen Weerasooriya; Thomas Rostock; Martin Manninger; Hubert Cochet; Ashok J Shah; Sunthareth Yeim; Arnaud Denis; Nicolas Derval; Meleze Hocini; Frederic Sacher; Michel Haissaguerre; Pierre Jais Journal: Circ Arrhythm Electrophysiol Date: 2014-12-20