Abstract 17748: Pulmonary Vein Antral Isolation in Sinus Rhythm Outcomes are Comparable to Ablation in Atrial Fibrillation in Patients with Long Standing AF (Mid-Term Results)
Introduction: Ablation of long standing persistent atrial fibrillation (AF) remains a challenge. We sought to determine outcomes comparing two strategies in this group of patients: PVI in sinus rhythm (SR) after DC cardioversion (DCC) vs. PVI and ablation targeting complex fractionated atrial electrograms (CFAE) while in AF.
Methods Between June 2009 and August 2011, 74 patients with long standing persistent AF resistant to anti-arrhythmic medications were prospectively enrolled and randomized to either DCC prior to PVI and ablation in SR (DCC first), or ablation in AF, including PVI and CFAE ablation, then DCC if the patient remains in AF (Ablation first). Duration of procedure, fluoroscopy times, radiation exposure doses, incidence of complications, and AF/AT burden post PVI as measured by weekly transtelephonic monitors, holters and ECG on outpatient follow up 4-6 months after PVI were compared.
Results: There were no differences in baseline patient characteristics between the two groups. 8 patients withdrew from the study prior to randomization. Overall 42/66 (65%) patients remained in SR at 6 months follow up. There was no significant difference in atrial arrhythmia recurrence between patients randomized to the DCC first vs Ablation first strategy (P=0.200). 9 out of 33 patients (27%) randomized to DCC first had recurrence; 6 developed paroxysmal AF and 2 persistent AF and 1 AT. 15 out of 33 patient (45%) randomized to Ablation first had recurrence; 7 developed paroxysmal AF and 8 persistent AF. One patient in the DCC first and 4 in the Ablation first group developed atrial flutter as well as AF. One patient randomized to DCC first developed moderate stenosis of the left superior pulmonary vein and another had a small hematoma that did not require interventions. Procedure duration and fluoroscopy time were significantly shorter in the DCC first strategy compared to the ablation first (225±65 min vs 276±87 min, P=0.009 and 59±17 min vs 70±25 min, P=0.041 respectively). CFAE mapping was done in 24 patients in Ablation first group vs only 3 in DCC first group (P<0.0001).
Conclusion: Additional ablation beyond antral PV isolation does not afford better outcomes in patients with long standing persistent AF and may result in more left sided atrial flutter.
- © 2012 by American Heart Association, Inc.