Abstract 12409: Patients with Paroxysmal Atrial Fibrillation and Severe Left Atrial Scarring: Comparison Between Scar “Homogeneization” and Triggers Ablation
Introduction: Left atrial (LA) scarring and fibrosis are independent predictor of ablation failure in patients with atrial fibrillation. The aim of this study was to compare the outcome in patients with paroxysmal AF and severe LA scarring/fibrosis identified by 3D mapping undergoing ablation of the PVs and the entire scar areas (scar homogemeization) vs the ablation of the PVs plus the non PV triggers.
Methods: 132 consecutive patients with paroxysmal atrial fibrillation have been enrolled in this study. In all patients severe ( 60%) LA scarring was diagnosed by 3D voltage mapping. Based on operator choice, patients underwent ablation of the pulmonary vein antrum extended to the entire scar areas [scar homogeneization (n=66 group 1)] or ablation of the pulmonary vein antrum plus the ablation of extra PV triggers identified by high dose of isoproterenol ( n=66 group 2). Patients were followed up for at least one year with Holter monitoring and event recorders.
Results: Baseline characteristics showed no significant statistical difference between groups. After a single procedure, freedom from atrial tachyarrhythmia off AADs at 24 ± 5 months follow up was 23% (15 pts) in group 1, and 68% (45 pts) in group 2. Kaplan-Meier log-rank test indicated that the cumulative probability of AF-free survival was significantly higher in group 2 (log-rank p <0.001, figure). No peri-procedural and thrombo-embolic complication were reported in these patients.
Conclusions: These results suggest that in patients with paroxysmal AF and severe LA scarring PVAI and scar “homogenization” does not improve freedom from atrial tachyarrhythmia at follow-up. In contrast non PV triggers ablation in addition to PV antrum isolation is associated with better clinical outcomes.
Author Disclosures: L. Di Biase: Honoraria; Modest; Biotronik, AtriCure Inc., EpiEP.. Consultant/Advisory Board; Modest; St. Jude Medical, Biosense Webster, Inc., Hansen Medical. P. Mohanty: None. S. Mohanty: None. C. Trivedi: None. R. Bai: None. P. Santangeli: None. J. Sanchez: None. P. Hranitzky: None. G. Gallinghouse: None. A. Al-Ahmad: None. J. Zagrodzky: None. R. Horton: None. R. Hongo: None. S. Hao: None. S. Beheiry: None. C. Elayi: None. D. Lakkireddy: None. M. Reddy: None. J. Viles-Gonzalez: None. J. Burkhardt: None. A. Natale: Speakers Bureau; Modest; Medtronic, Inc., Biotronik, Boston Scientific Corp.. Honoraria; Modest; Janssen Pharmaceuticals, Biosense Webster, Inc., St. Jude Medical..
- © 2014 by American Heart Association, Inc.