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Pulmonary vein isolation and linear lesions in atrial fibrillation ablation
Imran Sheikh1, David Krum, Ryan Cooley
1Electrophysiology Laboratories, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, WI, USA.
Insights
Adding linear lesions to pulmonary vein (PV) isolation for atrial fibrillation (AF) initially improved rhythm control. However, long-term results at nine months showed similar outcomes between groups, suggesting limited added benefit.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) ablation strategies vary, with ongoing debate on the efficacy of supplementary linear lesions.
- Pulmonary vein (PV) isolation is a common AF ablation technique.
Purpose of the Study:
- To evaluate the clinical benefits of incorporating linear lesions alongside PV isolation in AF patients.
- To compare the effectiveness of PV isolation alone versus PV isolation with linear lesions.
Main Methods:
- A randomized study included 100 patients with paroxysmal AF.
- Patients were assigned to either PV isolation alone or PV isolation with two linear lesions (superior PVs and left inferior PV to mitral annulus).
- Clinical outcomes were assessed at 1, 3, and 9 months post-ablation.
Main Results:
- At 1 month, the linear lesion group showed significantly higher sinus rhythm maintenance (86% vs. 58%) and fewer symptoms.
- At 9 months, no statistical difference was observed in maintaining sinus rhythm (90% vs. 82%), antiarrhythmic drug use, cardioversion needs, or subjective improvement between the groups.
- The linear lesion group required less additional management to maintain rhythm initially.
Conclusions:
- Adding linear lesions to PV isolation offers initial advantages in achieving sinus rhythm and reducing symptom burden.
- The long-term efficacy at 9 months suggests that the addition of linear lesions may not provide a sustained significant benefit over PV isolation alone.
- Further research may be needed to identify patient subgroups that could benefit more from adjunctive linear lesions.
Background:
Various strategies have been used for atrial fibrillation (AF) ablation. It is unclear whether adding linear lesions to pulmonary vein (PV) isolation has significant advantages.
Objectives:
We assessed the clinical benefit of adding linear lesions in patients undergoing PV isolation for AF.
Methods:
One hundred patients (63 male and 37 female; mean age of 59 +/- 11 years) with documented paroxysmal AF were included in the study. Patients were randomized into two groups. The first group underwent PV isolation alone. The second group underwent PV isolation and had two linear lesions created; one line between the superior PVs, and a second line from the left inferior PV to the mitral valve annulus. Patients' clinical progress after the ablation was evaluated and compared at 1, 3, and 9 months after their respective ablation procedures.
Results:
The linear lesions group maintained sinus rhythm and had fewer symptoms than the lone PV isolation group (86 vs. 58%, respectively) (p < 0.05) at 1 month. At 9 months, when patients who reverted to AF underwent additional management to regain sinus rhythm (90 vs. 82%, respectively) (p = NS), there was no statistical difference between the groups regarding the use of antiarrhythmics, the need for electrical cardioversion, and subjective improvement.
Conclusion:
The addition of linear lesions to PV isolation more effectively achieved sinus rhythm initially and fewer patients required additional management to maintain their rhythm when compared to patients who underwent lone PV isolation. However, at 9 months, the overall results were similar in both groups.
