Abstract 14953: Does Proven Additional Isolation of the Posterior Wall versus the Isolation of the Pulmonary Veins Alone Increase the Success Rate in Patients Undergoing Ablation for Paroxysmal AF? Results from a Prospective Multicenter Study
Introduction: Several metanalysis have shown that in patients (pts) with paroxysmal AF standard pulmonary vein (PV) isolation is sufficient to achieve freedom from AF after a single procedure at the one year follow up. No data exist in the literature on the very long term follow up. We sought to compare PVs isolation alone vs PV isolation plus posterior wall ablation at a very long term follow-up.
Methods: 194 consecutive pts undergoing ablation for paroxysmal AF were divided to pulmonary vein antrum isolation alone (PVAI) (group 1) versus PVAI plus posterior wall (PW) ablation (group 2). In the period between 3 to 6 months post ablation, irrespective of recurrences, pts underwent a left atrial catheterization to exclude the presence of PV reconnection. In case of reconnection, pts underwent re-isolation of the PVs and a third procedure was considered to confirm permanent isolation. Pts were given event recorders and followed up at 3, 6, 9, 12, and every three months thereafter for a minimum of three years.
Results: Group 1 consisted of 98 patients (60±11 years, 67% male, LVEF 60±8%, LA size 4.01±0.7 cm) while group 2 consisted of 96 patients (58±10 years, 66% male, LVEF 59±6%, LA size 4.20±0.57 cm). After a single procedure PVs remained isolated in 58% of the cases (113 pts). All pts with PV reconnection underwent re-isolation of the PVs. At the third procedure all PVs, except in 1 patient, remained isolated. At 1 year follow up, 84 (86%) pts in group 1 were recurrence-free, compared to 84 (87%) in group 2 (p=.72). After 46±6 months, the success rate off-AAD for group 1 was 54/98(55%), whereas 71/96(74%) pts were AF/AT free in group 2 (log-rankp=0.016) (figure). Multivariable analysis showed that, PVAI alone was associated with significantly higher risk of recurrence [hazard ratio 1.76 (1.1-2.7) p=.008].
Conclusions: The ablation of the posterior wall in addition to the antrum of the pulmonary veins increases the success rate of the ablation procedures at the long term follow up.
- © 2012 by American Heart Association, Inc.