Abstract 10997: Catheter Ablation of Non-paroxysmal Atrial Fibrillation Using Sinus Rhythm Defragmentation Plus Low Voltage Zone Homogenization After Pulmonary Vein Isolation: 30 Months’ Outcome From Nonrandomized Comparison With Stepwise Approach
Introduction: The high prevalence of postprocedural atrial tachycardia (AT) reduces the absolute arrhythmia-free success rate of extensive ablation strategies to treat non-paraxysmal atrial fibrillation (NPAF). We hypothesized that a strategy of targeting low voltage zones (LVZ) and sites with abnormal electrograms during sinus rhythm (SR-AEs) in the left atrium (LA) after circumferential pulmonary vein isolation (CPVI) and cavotricuspid isthmus (CTI) ablation in NPAF patients is superior to the widely practiced step-wise approach for NPAF ablation.
Methods and Results: 86 consecutive patients with NPAF (persistent or longstanding) were enrolled in study group. Following CPVI, CTI ablation and cardioversion to SR, high density mapping of LA was performed. Areas with LVZ and SR-AE were targeted for further homogenization and elimination respectively. 78 consecutive sex- and age- matched NPAF patients who were treated with the stepwise approach served as the historical control group. AF recurrence was assessed with Holters and regular clinic visits. In the study group, 92% (79/86) were successfully cardioverted after CPVI and CTI ablation. The remaining 8% (7/86) underwent further ablation in a stepwise approach to restore SR. Among the patients converted to SR, 70% (55/79) had LVZ and SR-AE and received additional ablation whereas in 30% (24/79) without SR-AE or LVZ, no further ablation was performed. Over the similar follow-up period (30 ± 8 vs. 33 ± 10 months), 66% (57/86) were free from recurrence and 3.5% (3/86) developed postprocedural AT after a single procedure in study group, compared to 37% (29/78) overall success rate and 30% (24/78) AT incidence in control group. (P=0.011 and P=0.0003, respectively).
Conclusions: A strategy of selective electrophysiological substrate modification in sinus rhythm after CPVI and CTI ablation is clinically more effective than the stepwise approach for NPAF ablation.
Author Disclosures: G. Yang: None. B. Yang: None. Y. Wei: None. F. Zhang: None. W. Ju: None. H. Chen: None. M. Li: None. K. Gu: None. Y. Lin: None. B. Wang: None. K. Cao: None. P. Kojodjojo: None. M. Chen: None.
- © 2015 by American Heart Association, Inc.