Long-Term Results of Pulmonary Vein Isolation Plus Modified Posterior Wall Debulking Utilizing High-Power Short-Duration Strategy: An All-Comers Study in Real World

Abstract

Background: High-power short-duration radiofrequency ablation has improved lesion durability in pulmonary vein isolation. In this study, we investigate long-term clinical out-comes of high-power short-duration pulmonary vein isolation and posterior wall debulk- ing as an initial treatment modality in all corner atrial fibrillation patients.

Methods: This is a single-center, retrospective, observational study including all patients who have undergone high-power short-duration pulmonary vein and posterior wall deb-ulking, regardless of atrial fibrillation type and/or duration. High-power short-duration power delivery protocol was defined as 45 W at all ablation sites. Clinical and electrocar-diographic follow-up were performed in all patients.

Results: One hundred forty-two patients were enrolled in this study. Paroxysmal atrial fibrillation was present in 88 (62%) of patients. The mean follow-up of this study was 36.9 months ± 12.2 months. During the follow-up period, 10 patients (11.4%) with a diag- nosis of paroxysmal atrial fibrillation had recurrence, while recurrence in patients with persistent and long-standing persistent atrial fibrillation was slightly higher (15 patients (28.1%) and 5 patients (50%), respectively). No major life-threatening complicationsoccurred.

Conclusion: This study has demonstrated excellent arrhythmia-free outcomes in unselected, real world atrial fibrillation patients undergoing high-power short-duration pulmonary vein and debulking posterior wall isolations, however larger randomized trials are warranted.

Figure 1.

Left atrial map with complete lesion set around left and right pulmonary veins. On the right side, in the posterior view, posterior wall debulking lesion set is visible.

Figure 2.

Kaplan–Maier arrhythmia-free survival plots for paroxysmal, persistent, and long-standing persistent atrial fibrillation patients.

Figure 3.

A patient who had undergone a box posterior wall isolation and pulmonary vein isolation at outside hospital. Although posterior wall was endocardially silent (bipolar signal visible at E1-2 on the left, side), pacing from posterior wall revealed constant capture at 4 mA. After posterior wall debulking exit block was accomplished.