Abstract 15935: Impact of Empirical Isolation of Left Atrial Appendage and/or Coronary Sinus on Procedure-outcome in Patients With Long-standing Persistent Atrial Fibrillation Without Any Evidence of Triggers and PV Reconnection During Repeat Catheter Ablation
Introduction: Emerging evidences from earlier trials have documented the crucial role of non-pulmonary vein (non-PV) triggers in maintenance of the arrhythmia in patients with long-standing persistent atrial fibrillation (LSPAF). Left atrial appendage (LAA) and coronary sinus (CS) are the two most common sites of origin of non-PV triggers. We compared the procedure-outcome of 3 ablation strategies including isolation of either LAA or CS or both in LSPAF patients undergoing repeat procedures.
Methods: One hundred eighty-six LSPAF patients showing permanent PV and posterior wall isolation during repeat ablation procedure for AF recurrence were included in this analysis. No additional triggers were elicited in these patients on high dose isoproterenol. Thus, based on operator’s choice the patients received empirical electrical isolation of LAA alone (group 1, n=40) or CS alone (group 2, n=58) or both LAA and CS (group 3, n=88). Patients were monitored for arrhythmia recurrence using event recorders for first 5 months and quarterly office visits, EKG and 7-day Holter monitoring for a minimum of two years. Recurrence was defined as an episode of AF, atrial flutter or atrial tachycardia of > 30 second duration off antiarrhythmic drugs (AAD) after 12 weeks of ablation procedure.
Results: Baseline characteristics were not significantly different across the groups (mean age was 64.3±12.1, 64.7±7.7, 65.7±10.4 years and 70%, 79.3% and 79.5% were male in groups 1, 2 and 3 respectively) . At 2 years, 20 (50%) in group 1, 30 (51.7%) in group 2 and 64 (73%) in group 3 were arrhythmia-free off AAD (log rank p= 0.009, unadjusted HR 0.56 [0.33-0.97], p=0.039). After adjusting for age and gender, isolation of LAA + CS predicted higher ablation-success (HR 0.52 [0.30-0.90], p=0.022).
Conclusion: Provocation of firings from non-PV foci with isoproterenol challenge is not always achievable. Our findings demonstrated that in LSPAF patients with permanent isolation of PVs and posterior wall, in the absence of detectable non-PV triggers, empirical isolation of left atrial appendage and coronary sinus is a reasonable option. Additionally, we observed significantly higher success rate with isolation of both structures compared to that of the appendage or the CS alone.
Author Disclosures: S. Mohanty: None. C. Trivedi: None. C. Gianni: None. J. Burkhardt: None. J. Sanchez: None. P. Hranitzky: None. G. Gallinghouse: None. A. Al-Ahmad: None. R. Horton: None. L. Di Biase: Speakers Bureau; Modest; Biotronik, EpiEP, Medtronic, Inc., Janssen Pharmaceuticals, Pfizer, Inc., Boston Scientific Corp.. Consultant/Advisory Board; Modest; Biosense Webster, Inc., St Jude Medical, Stereotaxis, Inc. A. Natale: Speakers Bureau; Modest; Boston Scientific Corp, Biotronik, Medtronic, Inc., Biosense Webster, Inc, St. Jude Medical. Consultant/Advisory Board; Modest; Janssen Pharmaceuticals, St. Jude Medical, Biosense Webster Inc..
- © 2016 by American Heart Association, Inc.