101. Long‐Term Outcome of Additional Superior Vena Cava to Septal Linear Ablation in Catheter Ablation of Atrial Fibrillation
- Author
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Boyoung Joung, Hui Nam Pak, Hee Tae Yu, Moo Nyun Jin, Jae Sun Uhm, Byounghyun Lim, Moon Hyoung Lee, Tae Hoon Kim, and Chun Hwang
- Subjects
Male ,Patient-Specific Modeling ,medicine.medical_specialty ,recurrence ,Vena Cava, Superior ,medicine.medical_treatment ,Operative Time ,Catheter ablation ,030204 cardiovascular system & hematology ,Autonomic Nervous System ,Right atrial ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Superior vena cava ,Heart Rate ,Internal medicine ,catheter ablation ,Atrial Fibrillation ,medicine ,Humans ,Arrhythmia and Electrophysiology ,Heart Atria ,Ganglia, Autonomic ,Original Research ,Aged ,Atrial Septum ,business.industry ,Atrial fibrillation ,Heart ,Middle Aged ,medicine.disease ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,superior vena cava ,Catheter Ablation and Implantable Cardioverter-Defibrillator ,030217 neurology & neurosurgery ,Linear ablation - Abstract
Background We previously reported the benefit of linear ablation from the superior vena cava to the right atrial septum ( SVC ‐L) within a year after circumferential pulmonary vein isolation ( CPVI ) in patients with paroxysmal atrial fibrillation ( AF ). We explored the long‐term effects of SVC ‐L and its potential related mechanisms. Methods and Results Among 2140 consecutive patients with AF ablation, we included 614 patients (73.3% male, aged 57.8±10.7 years, 13.7% with persistent AF ) who did not undergo an extra–pulmonary vein left atrial ablation after propensity score matching; of those, 307 had additional SVC ‐L and 307 had CPVI alone. We evaluated the heart rate variability and computational modeling study to explore mechanisms. Although the procedure time was longer in the SVC ‐L group than the CPVI group ( P P =0.560). During 40.5±24.4 months of follow‐up, the rhythm outcome was significantly better in the SVC ‐L group than the CPVI group (log rank, P P =0.018) and a lower ratio of low/high‐frequency components ( P =0.011) were found with SVC ‐L than CPVI alone. In realistic in silico biatrial modeling, which reflected the electroanatomies of 10 patients, SVC ‐L significantly reduced biatrial dominant frequency compared with CPVI alone ( P AF termination and defragmentation rates ( P =0.033). Conclusions SVC ‐L ablation in addition to CPVI significantly improved the long‐term rhythm outcome over 2 years after AF catheter ablation by mechanisms involving autonomic modulation and AF organization.
- Published
- 2019