Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation
Aims Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers. Methods and results Totally, 177 consecutive patients with PAF and severe LA scarring were included. Patients underwent PVAI only (n = 45, Group 1), PVAI+ scar homogenization (n = 66, Group 2) or PVAI+ ablation of non-PV triggers (n = 66, Group 3) based on operator's choice. Baseline characteristics were similar across the groups. After first procedure, all patients were followed-up for a minimum of 2 years. The success rate at the end of the follow-up was 18% (8 pts), 21% (14 pts), and 61% (40 pts) in Groups 1, 2, and 3, respectively. Cumulative probability of AF-free survival was significantly higher in Group 3 (overall log-rank P < 0.01, pairwise comparison 1 vs. 3 and 2 vs. 3 P <0.01). During repeat procedures, non-PV triggers were ablated in all. After average 1.5 procedures, the success rates were 28 (62%), 41 (62%), and 56 (85%) in Groups 1, 2, and 3, respectively (log-rank P < 0.001). Conclusion In patients with PAF and severe LA scarring, PVAI+ ablation of non-PV triggers is associated with significantly better long-term outcome than PVAI alone or PVAI+ scar homogenization.
第一作者机构:[1]St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, 3000 N IH-35,Suite 720, Austin, TX 78705 USA;[2]Univ Texas Austin, Dell Med Sch, Dept Internal Med, Austin, TX 78712 USA;
通讯作者:
通讯机构:[1]St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, 3000 N IH-35,Suite 720, Austin, TX 78705 USA;[2]Univ Texas Austin, Dell Med Sch, Dept Internal Med, Austin, TX 78712 USA;[4]Calif Pacific Med Ctr, San Francisco, CA 94114 USA;[10]Scripps Clin, San Diego, CA 92128 USA;[11]Stanford Univ, Div Cardiol, Palo Alto, CA 94304 USA
推荐引用方式(GB/T 7714):
Mohanty Sanghamitra,Mohanty Prasant,Di Biase Luigi,et al.Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation[J].EUROPACE.2017,19(11):1790-1797.doi:10.1093/europace/euw338.
APA:
Mohanty, Sanghamitra,Mohanty, Prasant,Di Biase, Luigi,Trivedi, Chintan,Morris, Eli Hamilton...&Natale, Andrea.(2017).Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation.EUROPACE,19,(11)
MLA:
Mohanty, Sanghamitra,et al."Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation".EUROPACE 19..11(2017):1790-1797