Abstract 2880: Atrial Fibrillation Termination Mode Comparing Three Common Ablation Strategies for Permanent Atrial Fibrillation: Results from a Randomized Study
Background: Ablation of permanent atrial fibrillation (perm-AF) is typically associated with lower success rate. Recent clinical observations suggested that AF termination during ablation of perm-AF, either by restoring sinus rhythm (SR) or by organization into an atrial tachyarrhythmia (AT), maybe associated with higher long-term maintenance of SR.
Objectives: We evaluated the mode of AF termination of three common ablation strategies for perm-AF.
Methods: One hundred and forty four consecutive patients with perm-AF presenting in AF were randomized to:
Pulmonary Vein Antrum Isolation (PVAI), N=48;
Hybrid approach: initial defragmentation, targeting bi-atrial and coronary sinus (CS) complex fractionated atrial electrograms (CFAE) and started randomly in the right or left atrium, followed by PVAI, N=49;
Large area circumferential ablation (LACA) targeting voltage reduction using electroanatomic mapping (CARTO), N=47.
The modes of AF termination were: conversion to SR, organization into AT or persistence of AF requiring cardioversion following ablation.
Results: They are shown below: There were no differences in sex, age, AF duration, LA size and LVEF in the three groups. SR was rarely restored with any of the three ablation strategies. AF organized into AT (cycle length 246.8±36.9 ms) more often in the defragmentation+ PVAI group (70%), less often in the PVAI group (38%) and rarely in the LACA group (11%), (p<0.001). However, bi-atrial and CS defragmentation alone, performed initially as part of the hybrid approach, almost never resulted in organization of AF into AT (only 1%).
Conclusions: Spontaneous conversion to sinus rhythm during ablation is rarely observed during any ablation strategy of perm-AF. The hybrid strategy (defragmentation+ PVAI) had a higher effect on AF termination (74% of cases), whereas the LACA strategy had little impact. Defragmentation alone almost never terminated AF in permanent AF patients