Abstract 16416: Non PV Triggers Ablation Improves the Success Rate of Catheter Ablation of Persistent Atrial Fibrillation After a Single Procedure: Results From a Prospective Multicenter Study
Introduction: Catheter ablation of persistent atrial fibrillation (AF) has a lower success rate when compared to paroxysmal AF patients. Whether in persistent AF patients ablation of the pulmonary vein antrum and posterior wall is sufficient to achieve long term freedom from AF is debated in the literature. We investigated if the ablation on non pv triggers from first procedure in addition to PV and posterior wall(PW) isolation could improve the procedural success rate.
Methods: 622 consecutive pts with persistent AF undergoing the first AF ablation were analysed and divided into 2 groups according to their ablation strategy. In group 1, pulmonary vein plus posterior wall ablation was performed (n=203) while in group 2 pulmonary veins plus posterior wall plus sustained and non sustained non pv triggers as disclosed by isoproterenol challenge were ablated. (n=419). All patients were followed up with intensive holter and event monitoring.
Results: Clinical baseline characteristics were not statistically different between groups. After 17.8 ± 8.8 months follow-up, 118(58.1%) Group I and 283 (67.5%) Group II patients were free from any atrial tachyarrhythmias (log-rank p= 0.027). After adjusting for age, gender and clinically relevant variables, PVI and PW ablation alone was associated with significantly high recurrence. (Hazard ratio: 1.4, 95% Confidence Interval = 1.1– 1.8, p=0.02). Further, Group I patients undergoing redo procedure after a failed ablation had more NPV trigger Group II (80% vs 60%, p = 0.002, respectively, figure), while the number of patients with PV reconnection were similar between groups (65% vs. 64%, p=1.0).
Conclusions: The results of our study shows that after a single procedure the ablation of non PV triggers, improves the long-term success rate in patients with persistent AF.
Author Disclosures: L. Di Biase: Honoraria; Modest; Biotronik, AtriCure Inc., EpiEP.. Consultant/Advisory Board; Modest; St. Jude Medical, Biosense Webster, Inc., Hansen Medical. C. Trivedi: None. P. Mohanty: None. S. Mohanty: None. R. Bai: None. P. Santangeli: None. J. Sanchez: None. R. Horton: None. G. Gallinghouse: None. J. Zagrodzky: None. S. Hao: None. R. Hongo: None. S. Beheiry: 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.