1. Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation without Additional Substrate Modification for Treating Longstanding Persistent Atrial Fibrillation.
- Author
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LIN, DAVID, FRANKEL, DAVID S., ZADO, ERICA S., GERSTENFELD, EDWARD, DIXIT, SANJAY, CALLANS, DAVID J., RILEY, MICHAEL, HUTCHINSON, MATHEW, GARCIA, FERMIN, BALA, RUPA, VERDINO, RALPH, COOPER, JOSHUA, and MARCHLINSKI, FRANCIS E.
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ATRIAL fibrillation prevention , *MYOCARDIAL depressants , *PULMONARY veins , *CATHETER ablation , *ACADEMIC medical centers , *ATRIAL fibrillation , *CONFIDENCE intervals , *STATISTICAL correlation , *LONGITUDINAL method , *SCIENTIFIC observation , *HEALTH outcome assessment , *REOPERATION , *STATISTICS , *T-test (Statistics) , *ATRIAL flutter , *DISEASE relapse , *LOGISTIC regression analysis , *DATA analysis , *TREATMENT effectiveness , *DATA analysis software , *DESCRIPTIVE statistics , *SURGERY , *THERAPEUTICS - Abstract
PV Ablation for Persistent Atrial Fibrillation. Introduction: Effectiveness of antral pulmonary vein isolation (PVAI) and ablation of non-PV triggers (non-PVTA) in controlling longstanding persistent atrial fibrillation (AF) has not been reported. We sought to describe clinical outcomes with this ablation strategy in patients (pts) followed for at least 1 year. Methods: Two hundred pts underwent PVAI for longstanding persistent AF and were followed for recurrence. Thirty-three pts with <1-year follow-up and 37 pts with additional RF atrial ablation were excluded, leaving 130 pts for analysis. Results: All 130 pts (108 men, mean LA 4.7 ± 0.6 cm, mean AF duration of 38 ± 44 months) underwent PVAI with entrance/exit block. In addition, 24 pts (15 pts during the initial procedure and 9 additional pts at repeat ablations) had 40 non-PVTA, including 3 with AVNRT. During follow-up, atrial flutter (AFL) was noted in 7 (5%) pts. The AF-free survival after single procedure without antiarrhythmic drugs (AAD) was 38%. Repeat AF or AFL ablation was performed in 37 pts (28%) with PV reconnection uniformly identified (3.7 ± 0.5 veins/pt). During mean follow-up of 41.1 ± 23.8 months (range 12-103 months), 85/130 pts (65%) were in sinus rhythm with 65 pts (50%) off AAD, 20 pts (15%) on AAD. Additionally, 9 pts (7%) have had rare episodes of AF such that 72% of pts have had good long-term clinical outcome. Of the 36 pts with recurrent AF, 20 pts have not had a repeat procedure. Conclusions: PVAI with non-PVTA for longstanding persistent AF provides good long-term AF control in over 70% of patients with infrequent (5%) AFL. AAD therapy and repeat PVAI may be required for this optimal outcome. (J Cardiovasc Electrophysiol, Vol. 23, pp. 806-813, August 2012) [ABSTRACT FROM AUTHOR]
- Published
- 2012
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