A PVI-only strategy in PeAF patients with a low prevalence of structural heart disease using contemporary technology yields excellent outcomes comparable to those for paroxysmal AF ablation
BACKGROUND Early studies demonstrated relatively low success rates for pulmonary vein isolation ( PVI ) alone in patients with persistent atrial fibrillation ( PeAF ) .
However , the advent of new technologies and the observation that additional substrate ablation does not improve outcomes have created a new focus on PVI alone for treatment of PeAF .
OBJECTIVE The purpose of this study was to systematic ally review the recent medical literature to determine current medium-term outcomes when a PVI-only approach is used for PeAF .
One-year follow-up after irrigated multi-electrode radiofrequency ablation of persistent atrial fibrillation.
AIMS Irrigated multi-electrode ablation ( IMEA ) is a novel tool to perform pulmonary vein isolation ( PVI ) . The aim was to compare IMEA with point-by-point radiofrequency ( RF ) ablation in patients with persistent atrial fibrillation ( AF ) undergoing PVI . METHODS AND RESULTS Forty-nine patients ( age 60 ± 9 years , 82 % male ) were studied . In 24 patients , the IMEA catheter was used in conjunction with an electroanatomic mapping system . Twenty-five patients undergoing RF point-by-point ablation ( RF-PVI ) served as a control group . Validation of PVI based on the IMEA catheter was performed using a st and ard circular mapping catheter . Ninety-two of 94 pulmonary veins ( PVs ) ( 98 % ) were isolated using IMEA alone . Procedure time was 125 ± 23 min in the IMEA group and 127 ± 31 min in the RF-PVI group ( P = 0.79 ) . Fluoroscopy time was 12.2 ( 11 - 16.1 ) min with IMEA compared with 5.2 ( 4.1 - 9.3 ) min in the RF-PVI group ( P < 0.001 ) . Net ablation time was 11.8 ( 10.2 - 15.4 ) min in the IMEA group compared with 33.6 ( 30.3 - 40.1 ) min in the RF-PVI group ( P < 0.001 ) . Of 94 PVs presumed to be isolated after IMEA ablation , validation using a st and ard circular mapping catheter showed persistent PV potentials in 33 PVs ( 35 % ) , requiring additional IMEA ablation . At 12 months , 16 of 24 patients ( 67 % ) in the IMEA group compared with 17 of 25 patients ( 68 % ) in RF-PVI group were free from AF ( P > 0.99 ) . CONCLUSION With similar total procedure duration , IMEA-PVI was associated with shorter net ablation time and longer fluoroscopy time . Irrigated multi-electrode ablation recordings were not sufficient to confirm isolation in 35 % of PVs . Single-procedure efficacy after 12 months was similar between the two groups
A PVI-only strategy in PeAF patients with a low prevalence of structural heart disease using contemporary technology yields excellent outcomes comparable to those for paroxysmal AF ablation
BACKGROUND Early studies demonstrated relatively low success rates for pulmonary vein isolation ( PVI ) alone in patients with persistent atrial fibrillation ( PeAF ) .
However , the advent of new technologies and the observation that additional substrate ablation does not improve outcomes have created a new focus on PVI alone for treatment of PeAF .
OBJECTIVE The purpose of this study was to systematic ally review the recent medical literature to determine current medium-term outcomes when a PVI-only approach is used for PeAF .