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. 2023 Jun;66(4):971-979.
doi: 10.1007/s10840-022-01402-x. Epub 2022 Nov 3.

Posterior wall isolation in persistent atrial fibrillation. Long-term outcomes of a repeat procedure strategy

René Worck  1 , Samuel K Sørensen  2 , Arne Johannessen  2 , Martin H Ruwald  2 , Morten Lock Hansen  2 , Martin Haugdal  2 , Jim Hansen  2
Affiliations

Posterior wall isolation in persistent atrial fibrillation. Long-term outcomes of a repeat procedure strategy

René Worck et al. J Interv Card Electrophysiol. 2023 Jun.

Abstract

Background: Posterior wall isolation (PWI) added to pulmonary vein isolation (PVI) is increasingly used in ablation for persistent atrial fibrillation (PeAF) despite limited evidence of clinical benefit. We investigated the 5-year outcomes of a PVI + PWI ablation strategy with mandatory repeat procedures in PeAF.

Methods: Twenty-four patients with PeAF participated in this single-arm prospective study and underwent radiofrequency ablation (RFA) with wide area circumferential ablation (WACA), roof, and inferior lines for PVI + PWI which was reinforced if required during mandated repeat procedures after 6 months. Then, patients were followed for 60 months using continuous heart rhythm monitoring by implanted cardiac monitors (ICM) and atrial fibrillation effect on quality-of-life scoring (AFEQT; range: 20-100 points) for the initial 30 months.

Results: ICM-verified cumulated AF recurrence was 54% after 30 months but the ensuing AF burden was only median 0‰ [0 to 4.8‰] overall and 1‰ [0 to 8 ‰] among patients with any recurrence. AFEQT scores increased from baseline 60 points [48 to 72] to 93 points [84 to 96] at repeat procedures P < 0.0001 and further to 96 points [93 to 99] P = 0.03 after 30 months. After 60 months, at least one episode of AF had been documented in 63% and two patients (8%) were in permanent AF.

Conclusion: Reinforced PVI + PWI was associated with low long-term AF burden and corresponding improvements in quality-of-life. Reinforced (or durable) PVI + PWI appears to be a promising strategy to treat PeAF.

Trial registration: ClinicalTrials.gov. Identifier: NCT05045131.

Keywords: Continuous rhythm monitoring; Long-term outcomes; Mandated repeat ablation; Persistent atrial fibrillation; Posterior wall.

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References

    1. Bai R, Di BL, Mohanty P, et al. Proven isolation of the pulmonary vein antrum with or without left atrial posterior wall isolation in patients with persistent atrial fibrillation. Heart Rhythm. 2016;13(1547–5271 (Linking)):132–140. https://doi.org/10.1016/j.hrthm.2015.08.019
    1. Barbhaiya CR, Knotts RJ, Beccarino N, et al. Multiple procedure outcomes for nonparoxysmal atrial fibrillation: left atrial posterior wall isolation versus stepwise ablation. J Cardiovasc Electrophysiol. 2020;31(12):3117–23. https://doi.org/10.1111/jce.14771 . - DOI - PubMed
    1. Jiang X, Liao J, Ling Z, et al. Adjunctive left atrial posterior wall isolation in treating atrial fibrillation. JACC: Clinical Electrophysiol. 2022;8(5):605–18. https://doi.org/10.1016/j.jacep.2022.02.001 . - DOI
    1. Worck R, Sørensen SK, Johannessen A, Ruwald M, Haugdal M, Hansen J. Posterior wall isolation in persistent atrial fibrillation feasibility, safety, durability, and efficacy. J Cardiovasc Electrophysiol. 2022;33(8):1667–74. https://doi.org/10.1111/jce.15556 . - DOI - PubMed - PMC
    1. Verma A (2022) Strategies for catheter ablation of persistent atrial fibrillation: a randomized, comparative study. Clin Trials.gov; 2022. Accessed 4 Jul 2022. https://clinicaltrials.gov/ct2/show/NCT04428944

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