Long‐term outcomes of catheter ablation in patients with longstanding persistent atrial fibrillation lasting less than 2 years

Domenico G Della Rocca; Sanghamitra Mohanty; Prasant Mohanty; Chintan Trivedi; Carola Gianni; Amin Al‐Ahmad; J. David Burkhardt; G. Joseph Gallinghouse; Patrick Hranitzky; Javier E. Sanchez; Rodney P. Horton; Luigi Di Biase; Andrea Natale

doi:10.1111/jce.13721

journal article Sep 24, 2018

Long‐term outcomes of catheter ablation in patients with longstanding persistent atrial fibrillation lasting less than 2 years

Domenico G Della Rocca Sanghamitra Mohanty Prasant Mohanty Chintan Trivedi Carola Gianni

Amin Al‐Ahmad

J. David Burkhardt G. Joseph Gallinghouse Patrick Hranitzky Javier E. Sanchez Rodney P. Horton Luigi Di Biase

Andrea Natale

Journal of Cardiovascular Electrophysiology Vol. 29 No. 12 pp. 1607-1615 · Wiley

View at Publisher Save 10.1111/jce.13721

Abstract

AbstractIntroductionOutcome 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 ResultsIn 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).ConclusionIn 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.

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Details

Published: Sep 24, 2018
Vol/Issue: 29(12)
Pages: 1607-1615
License: View

Authors

D

Domenico G Della Rocca

Texas Cardiac Arrhythmia Institute, St. David's Medical Center Austin Texas; Department of Cardiovascular Medicine University of Tor Vergata Rome Italy

S

Sanghamitra Mohanty