Safety and efficacy outcomes of left atrial posterior wall isolation compared to pulmonary vein isolation and pulmonary vein isolation with linear ablation for the treatment of persistent atrial fibrillation.
Am Heart J
; 220: 89-96, 2020 02.
Article
em En
| MEDLINE
| ID: mdl-31805423
ABSTRACT
BACKGROUND:
Pulmonary wall isolation (PWI) is increasingly used as an adjunctive lesion set to compliment pulmonary vein isolation (PVI), especially in patients with persistent atrial fibrillation (AF). The objective was to compare outcomes of catheter ablation in patients with persistent AF undergoing PVI with and without adjunctive PWI.METHODS:
We performed a retrospective study of 558 patients who underwent de novo and repeat ablation for persistent AF. Subjects were matched using propensity score adjustments. Outcomes were freedom from recurrent atrial arrhythmia and adverse events.RESULTS:
Among 558 patients who underwent ablation for persistent AF, 78 (14%) underwent PVIâ¯+â¯PWI, 255 (46%) underwent PVI, and 225 (40%) underwent PVIâ¯+â¯linear ablation. Stratified logistic regression analysis with propensity matching revealed higher odds of recurrent arrhythmia with PVIâ¯+â¯PWI when compared to PVI (odds ratio [OR] 2.25, 95% CI 1.08-4.69, Pâ¯=â¯.030) and when compared to PVIâ¯+â¯linear (OR 2.31, 95% CI 1.01-5.28, Pâ¯=â¯.048). Within the PVIâ¯+â¯PWI group, 57.7% of subjects were in normal sinus rhythm at 6â¯months compared to 73.9% and 72.2% in PVI and PVIâ¯+â¯linear groups, respectively. Adverse events were rare, with 19 events total identified across all groups.CONCLUSIONS:
PVIâ¯+â¯PWI does not appear to be as effective as PVI or PVIâ¯+â¯linear ablation in reducing the recurrence of arrhythmia within 6â¯months of the index procedure in patients with persistent AF. A prospective, randomized controlled trial comparing these ablation techniques is needed to clarify the role of extensive substrate modification for treatment of persistent AF. CONDENSED ABSTRACT PWI is increasingly used as an adjunctive lesion set to compliment PVI in patients with persistent AF. We performed a retrospective study of 558 patients who underwent de novo and repeat ablation for persistent AF to compare the outcomes between PVI with and without adjunctive PWI. We found an increased incidence in recurrence of AF and other atrial arrhythmias at 6â¯months in the PVIâ¯+â¯PWI cohort compared to PVI with or without additional linear ablation. A prospective, randomized controlled trial comparing these ablation techniques is needed to clarify the role of extensive substrate modification for treatment of persistent AF.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Veias Pulmonares
/
Fibrilação Atrial
/
Átrios do Coração
/
Pulmão
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article