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Contact-Force Guided Posterior Wall Isolation as an Adjunctive Ablation Strategy for Persistent Atrial Fibrillation.
Sirico, Giusy; Sirico, Domenico; Montisci, Andrea; Cerrato, Enrico; Morosato, Martina; Panigada, Stefania; Ottaviano, Luca; De Sanctis, Valerio; Mantica, Massimo.
Afiliação
  • Sirico G; Department of Cardiac Electrophysiologist and Pacing, Istituto Clinico Sant'Ambrogio, Milan, Italy.
  • Sirico D; Pediatric and Congenital Cardiology Unit, Department of Woman and Child's Health, University of Padova, Padova, Italy.
  • Montisci A; Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy and Chair of Cardiac Surgery, Postgraduate in Cardiac Surgery, University of Milan, Italy.
  • Cerrato E; Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy and Chair of Cardiac Surgery, Postgraduate in Cardiac Surgery, University of Milan, Italy.
  • Morosato M; Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy and Chair of Cardiac Surgery, Postgraduate in Cardiac Surgery, University of Milan, Italy.
  • Panigada S; Department of Cardiac Electrophysiologist and Pacing, Istituto Clinico Sant'Ambrogio, Milan, Italy.
  • Ottaviano L; Department of Cardiac Electrophysiologist and Pacing, Istituto Clinico Sant'Ambrogio, Milan, Italy.
  • De Sanctis V; Department of Cardiac Electrophysiologist and Pacing, Istituto Clinico Sant'Ambrogio, Milan, Italy.
  • Mantica M; Department of Cardiac Electrophysiologist and Pacing, Istituto Clinico Sant'Ambrogio, Milan, Italy.
J Atr Fibrillation ; 14(2): 20200475, 2021 Aug.
Article em En | MEDLINE | ID: mdl-34950369
ABSTRACT

BACKGROUND:

The efficacy of posterior wall isolation (PWI) on top of pulmonary vein isolation (PVI) in patients affected by persistent atrial fibrillation (AF) is still controversial and little is known about the impact of contact-force (CF) technology.

OBJECTIVE:

In this retrospective study, we present our experience with PWI using CF sensing catheters and its efficacy and safety as an adjunctive ablation strategy on top of PVI for management of patients with persistent and longstanding persistent AF.

METHODS:

A total of 73 consecutive patients (20.5% female) affected by persistent atrial fibrillation (10.9% long-standing) underwent PWI as an adjunctive therapy to PVI using CF sensing catheters. Outcomes were reported as incidence of atrial arrhythmic recurrences (ARs) lasting >30 seconds at follow up and in addition, in patients provided with insertable cardiac monitors (ICM), as burden of AF or atrial tachycardias (AT) at relevant time points.

RESULTS:

PWI was successfully achieved in 65 (89.0%) patients. Two (2.7%) minor vascular procedural complications were observed. At 1 and 2-year follow-up, ARs free survival was observed in 80.5% and 64.1% of patients, respectively with 75.3% of patients off antiarrhythmic drugs at the last follow-up. Ten patients underwent repeat ablations during the follow-up. At multivariate analysis, early ARs within 3 months after procedure, were associated with a two-fold increased risk of late ARs at follow-up. Among patients provided with ICM, PWI on top of PVI was able to reduce the mean AT/AF burden of more than 50% compared with pre-ablation time, reporting very low levels (≤ 5%) over 2 years.

CONCLUSIONS:

In persistent atrial fibrillation, PWI on top of PVI using CF sensing catheters is safe and effective, providing great reduction of burden of ARs. Early ARs are associated with a greater risk of late recurrences.
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Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Observational_studies / Risk_factors_studies Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Observational_studies / Risk_factors_studies Idioma: En Ano de publicação: 2021 Tipo de documento: Article