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Targeted ablation of specific electrogram patterns in low-voltage areas after pulmonary vein antral isolation in persistent atrial fibrillation: Termination to an organized rhythm reduces atrial fibrillation recurrence.

Abstract：

BACKGROUND:Ablation strategies have been developed to improve outcomes in patients with persistent atrial fibrillation (PsAF). However, the impact of atrial fibrillation (AF) termination on late AF recurrence is not well known. The aim of our study was to evaluate the impact of AF termination to atrial tachycardia (AT) or sinus rhythm (SR) during catheter ablation on late AF recurrence after the 3-month blanking period. METHODS AND RESULTS:We prospectively recruited 140 patients (mean age: 58.5 ± 12.3 years old, 74.3% males) with uninterrupted PsAF of a mean duration of 3.7 months. Pulmonary vein antral isolation (PVAI) was the first ablation step, and if AF did not terminate (to SR or AT), we ablated low-voltage areas less than 0.4 mV with specific electrogram characteristics. We successfully converted AF to AT or SR in 56 patients (40%) during PVAI (n = 24) or low-voltage ablation ( n = 32). The remaining 84 patients (60%) were electrically cardioverted to SR at the end of the procedure. One hundred patients (71.4%) maintained SR after a single procedure during a mean follow-up of 21.1 ± 0.8 months. Of the 56 patients with AF termination, 46 (82.1%) had no recurrence, while in the group of 84 patients without AF termination, 54 patients (64.3%) remained in SR ( P < 0.02). CONCLUSION:Ablation of PVAI and specific electrograms in low-voltage areas less than 0.4 mV can lead to encouraging outcomes with a low recurrence rate as well as a lower need for redo procedures.

journal_name

J Cardiovasc Electrophysiol

journal_title

Journal of cardiovascular electrophysiology

authors

Efremidis M,Vlachos K,Letsas KP,Bazoukis G,Martin R,Frontera A,Asvestas D,Saplaouras A,Kitamura Τ,Georgopoulos S,Valkanas K,Karamichalakis N,Takigawa M,Sideris A,Derval N,Sacher F,Jais P

doi

10.1111/jce.13763

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

47-57

issue

eissn

1045-3873

issn

1540-8167

journal_volume

pub_type

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Targeted ablation of specific electrogram patterns in low-voltage areas after pulmonary vein antral isolation in persistent atrial fibrillation: Termination to an organized rhythm reduces atrial fibrillation recurrence.