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Clinical Trial
. 2020 Dec;31(12):3117-3123.
doi: 10.1111/jce.14771. Epub 2020 Oct 18.

Multiple procedure outcomes for nonparoxysmal atrial fibrillation: Left atrial posterior wall isolation versus stepwise ablation

Chirag R Barbhaiya  1 , Robert J Knotts  1 , Nicholas Beccarino  1 , Alvaro F Vargas-Pelaez  1 , Lior Jankelson  1 , Scott Bernstein  1 , David Park  1 , Douglas Holmes  1 , Anthony Aizer  1 , Larry A Chinitz  1
Affiliations
Clinical Trial

Multiple procedure outcomes for nonparoxysmal atrial fibrillation: Left atrial posterior wall isolation versus stepwise ablation

Chirag R Barbhaiya et al. J Cardiovasc Electrophysiol. 2020 Dec.

Abstract

Objective: To compare multiple-procedure catheter ablation outcomes of a stepwise approach versus left atrial posterior wall isolation (LA PWI) in patients undergoing nonparoxysmal atrial fibrillation (NPAF) ablation.

Background: Unfavorable outcomes for stepwise ablation of NPAF in large clinical trials may be attributable to proarrhythmic effects of incomplete ablation lines. It is unknown if a more extensive initial ablation strategy results in improved outcomes following multiple ablation procedures.

Methods: Two hundred twenty two consecutive patients with NPAF underwent first-time ablation using a contact-force sensing ablation catheter utilizing either a stepwise (Group 1, n = 111) or LA PWI (Group 2, n = 111) approach. The duration of follow-up was 36 months. The primary endpoint was freedom from atrial arrhythmia >30 s. Secondary endpoints were freedom from persistent arrhythmia, repeat ablation, and recurrent arrhythmia after repeat ablation.

Results: There was similar freedom from atrial arrhythmias after index ablation for both stepwise and LA PWI groups at 36 months (60% vs. 69%, p = .1). The stepwise group was more likely to present with persistent recurrent arrhythmia (29% vs. 14%, p = .005) and more likely to undergo second catheter ablation (32% vs. 12%, p < .001) compared to LA PWI patients. Recurrent arrhythmia after repeat ablation was more likely in the stepwise group compared to the LA PWI group (15% vs. 4%, p = .003).

Conclusions: Compared to a stepwise approach, LA PWI for patients with NPAF resulted in a similar incidence of any atrial arrhythmia, lower incidence of persistent arrhythmia, and fewer repeat ablations. Results for repeat ablation were not improved with a more extensive initial approach.

Keywords: atrial fibrillation; catheter ablation; contact-force sensing; posterior wall isolation; procedural outcomes; radiofrequency ablation; stepwise.

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References

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