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. 2020 Apr 30;12(6):2280.
doi: 10.4022/jafib.2280. eCollection 2020 Apr-May.

Anatomy Versus Physiology-Guided Ablation for Persistent Atrial Fibrillation

Abhishek Deshmukh  1 , Li Zhong  1 , Joshua Slusser  2 , Peilin Xiao  1 , Pei Zhang  1 , David Hodge  2 , Mélèze Hocini  3 , Christopher McLeod  1 , David Bradley  1 , Thomas Munger  1 , Douglas Packer  1 , Yong-Mei Cha  1
Affiliations

Anatomy Versus Physiology-Guided Ablation for Persistent Atrial Fibrillation

Abhishek Deshmukh et al. J Atr Fibrillation. .

Abstract

Background: Pulmonary vein isolation remains the cornerstone of atrial fibrillation (AF) ablation. However, due to high recurrence rates, especially in patients with persistent AF, PV antral isolation, complemented by linear ablation, autonomic modulation, and ablation of complex fractionated electrograms, have been attempted to increase the odds of success. However, the optimum approach for a complementary strategy in addition to PVI for persistent AF is unknown.

Methods: We performed a prospective randomized trial by assigning 92 patients with persistent AF in 1:1 ratio to pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity (45 patients), or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus (47 patients). The duration of follow-up was five years. The primary endpoint was freedom from any documented recurrence of atrial fibrillation after a single ablation procedure.

Results: At a 12-month follow-up, 9 (23%) patients had AF recurrence in the linear ablation and 8 (21%) patients in the CFAE groups. At a mean follow-up duration of 59±36 months, 48.3% of patients in the linear ablation group and 44.6% of patients in the CFAE group were free from AF (p=0.403). There were no significant differences between the two groups for independent predictors of freedom from AF. The overall procedure time and radiation exposure were higher in the PVI+linear ablation group. There were five adverse events noted, two in the linear group (pericardial effusion not requiring drain) and 3 in the CFAE group (1 pseudoaneurysm, one effusion requiring pericardiocentesis and one effusion nor requiring drain).

Conclusions: Among patients with persistent atrial fibrillation, we found no difference in maintenance of sinus rhythm in either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary vein isolation in short- and long-term follow-up.

Keywords: Atrial Fibrillation; Post-Operative Atrial Fibrillation; Time Varying Risk; Valvular Heart Surgery.

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Figures

Figure 1.
Figure 1.. Schematic of common lesion sets employed in AF ablation. A: The circumferential ablation lesions that are created in a circumferential fashion around the right and the left PVs and linear ablation line in the left atrial room and mitral isthmus. B: Ablation targeting complex fractionated activity electrograms (CFAE). Modified with permission from Calkins et al. Heart Rhythm 2012; 9:632–696.e21.2
Figure 2.
Figure 2.. Shows Kaplan-Meier AF free rate at short-term and long-term follow-up post PVI+linear and PVI+CFAE ablations.
See this image and copyright information in PMC

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References

    1. Haïssaguerre M, Jaïs P, Shah D C, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Métayer P, Clémenty J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N. Engl. J. Med. 1998 Sep 03;339 (10):659–66. - PubMed
    1. Calkins Hugh, Kuck Karl Heinz, Cappato Riccardo, Brugada Josep, Camm A John, Chen Shih-Ann, Crijns Harry J G, Damiano Ralph J, Davies D Wyn, DiMarco John, Edgerton James, Ellenbogen Kenneth, Ezekowitz Michael D, Haines David E, Haissaguerre Michel, Hindricks Gerhard, Iesaka Yoshito, Jackman Warren, Jalife José, Jais Pierre, Kalman Jonathan, Keane David, Kim Young-Hoon, Kirchhof Paulus, Klein George, Kottkamp Hans, Kumagai Koichiro, Lindsay Bruce D, Mansour Moussa, Marchlinski Francis E, McCarthy Patrick M, Mont J Lluis, Morady Fred, Nademanee Koonlawee, Nakagawa Hiroshi, Natale Andrea, Nattel Stanley, Packer Douglas L, Pappone Carlo, Prystowsky Eric, Raviele Antonio, Reddy Vivek, Ruskin Jeremy N, Shemin Richard J, Tsao Hsuan-Ming, Wilber David. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012 Apr;9 (4):632–696.e21. - PubMed
    1. Oral Hakan, Pappone Carlo, Chugh Aman, Good Eric, Bogun Frank, Pelosi Frank, Bates Eric R, Lehmann Michael H, Vicedomini Gabriele, Augello Giuseppe, Agricola Eustachio, Sala Simone, Santinelli Vincenzo, Morady Fred. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N. Engl. J. Med. 2006 Mar 02;354 (9):934–41. - PubMed
    1. Calkins Hugh, Hindricks Gerhard, Cappato Riccardo, Kim Young-Hoon, Saad Eduardo B, Aguinaga Luis, Akar Joseph G, Badhwar Vinay, Brugada Josep, Camm John, Chen Peng-Sheng, Chen Shih-Ann, Chung Mina K, Nielsen Jens Cosedis, Curtis Anne B, Davies D Wyn, Day John D, d'Avila André, de Groot N M S Natasja, Di Biase Luigi, Duytschaever Mattias, Edgerton James R, Ellenbogen Kenneth A, Ellinor Patrick T, Ernst Sabine, Fenelon Guilherme, Gerstenfeld Edward P, Haines David E, Haissaguerre Michel, Helm Robert H, Hylek Elaine, Jackman Warren M, Jalife Jose, Kalman Jonathan M, Kautzner Josef, Kottkamp Hans, Kuck Karl Heinz, Kumagai Koichiro, Lee Richard, Lewalter Thorsten, Lindsay Bruce D, Macle Laurent, Mansour Moussa, Marchlinski Francis E, Michaud Gregory F, Nakagawa Hiroshi, Natale Andrea, Nattel Stanley, Okumura Ken, Packer Douglas, Pokushalov Evgeny, Reynolds Matthew R, Sanders Prashanthan, Scanavacca Mauricio, Schilling Richard, Tondo Claudio, Tsao Hsuan-Ming, Verma Atul, Wilber David J, Yamane Teiichi. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace. 2018 Jan 01;20 (1):157–208. - PMC - PubMed
    1. Verma Atul, Jiang Chen-yang, Betts Timothy R, Chen Jian, Deisenhofer Isabel, Mantovan Roberto, Macle Laurent, Morillo Carlos A, Haverkamp Wilhelm, Weerasooriya Rukshen, Albenque Jean-Paul, Nardi Stefano, Menardi Endrj, Novak Paul, Sanders Prashanthan. Approaches to catheter ablation for persistent atrial fibrillation. N. Engl. J. Med. 2015 May 07;372 (19):1812–22. - PubMed

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