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Safety and efficacy outcomes of left atrial posterior wall isolation compared to pulmonary vein isolation and pulmonary vein isolation with linear ablation for the treatment of persistent atrial fibrillation
- Source :
- American heart journal. 220
- Publication Year :
- 2019
-
Abstract
- Background Pulmonary wall isolation (PWI) is increasingly used as an adjunctive lesion set to compliment pulmonary vein isolation (PVI), especially in patients with persistent atrial fibrillation (AF). The objective was to compare outcomes of catheter ablation in patients with persistent AF undergoing PVI with and without adjunctive PWI. Methods We performed a retrospective study of 558 patients who underwent de novo and repeat ablation for persistent AF. Subjects were matched using propensity score adjustments. Outcomes were freedom from recurrent atrial arrhythmia and adverse events. Results Among 558 patients who underwent ablation for persistent AF, 78 (14%) underwent PVI + PWI, 255 (46%) underwent PVI, and 225 (40%) underwent PVI + linear ablation. Stratified logistic regression analysis with propensity matching revealed higher odds of recurrent arrhythmia with PVI + PWI when compared to PVI (odds ratio [OR] 2.25, 95% CI 1.08-4.69, P = .030) and when compared to PVI + linear (OR 2.31, 95% CI 1.01-5.28, P = .048). Within the PVI + PWI group, 57.7% of subjects were in normal sinus rhythm at 6 months compared to 73.9% and 72.2% in PVI and PVI + linear groups, respectively. Adverse events were rare, with 19 events total identified across all groups. Conclusions PVI + PWI does not appear to be as effective as PVI or PVI + linear ablation in reducing the recurrence of arrhythmia within 6 months of the index procedure in patients with persistent AF. A prospective, randomized controlled trial comparing these ablation techniques is needed to clarify the role of extensive substrate modification for treatment of persistent AF. Condensed Abstract PWI is increasingly used as an adjunctive lesion set to compliment PVI in patients with persistent AF. We performed a retrospective study of 558 patients who underwent de novo and repeat ablation for persistent AF to compare the outcomes between PVI with and without adjunctive PWI. We found an increased incidence in recurrence of AF and other atrial arrhythmias at 6 months in the PVI + PWI cohort compared to PVI with or without additional linear ablation. A prospective, randomized controlled trial comparing these ablation techniques is needed to clarify the role of extensive substrate modification for treatment of persistent AF.
- Subjects :
- Male
Reoperation
medicine.medical_specialty
medicine.medical_treatment
Catheter ablation
030204 cardiovascular system & hematology
Severity of Illness Index
Pulmonary vein
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Recurrence
Internal medicine
Severity of illness
Atrial Fibrillation
medicine
Secondary Prevention
Humans
030212 general & internal medicine
Heart Atria
Adverse effect
Propensity Score
Lung
Aged
Retrospective Studies
business.industry
Retrospective cohort study
Odds ratio
Middle Aged
Ablation
Treatment Outcome
Pulmonary Veins
Cardiology
Regression Analysis
Female
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Subjects
Details
- ISSN :
- 10976744
- Volume :
- 220
- Database :
- OpenAIRE
- Journal :
- American heart journal
- Accession number :
- edsair.doi.dedup.....afe99ff02e9435580bc6fd0b65f563f7