Results of complex left atrial ablation of long-lasting persistent atrial fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Atrial fibrillation (AF) is a common arrhythmia impacting cardiovascular health.
• Persistent AF poses challenges for successful rhythm control.
• Catheter ablation is a key therapeutic strategy for managing AF.

Purpose of the Study:

• To identify predictors of sustained sinus rhythm (SR) following a single catheter ablation procedure for long-standing persistent AF.
• To evaluate clinical and electrophysiological variables associated with long-term SR maintenance.

Main Methods:

• A cohort of 100 patients with long-lasting persistent AF underwent complex left atrial (LA) ablation.
• The primary endpoint was the restoration and maintenance of SR post-ablation.
• Analysis focused on correlating baseline patient and procedural characteristics with long-term SR outcomes.

Main Results:

• Of 100 patients, 38 achieved SR during the initial procedure, with 50 maintaining SR for 31 ± 14 months post-single ablation.
• Shorter duration of persistent AF (median 14 vs. 22 months, P=0.05) was associated with SR maintenance.
• Lower proportion of LA low-voltage (<0.2 mV) areas (median 20% vs. 33%, P=0.006) and higher proportion of LA high-voltage (>1 mV) areas (median 15% vs. 11%, P=0.02) predicted successful SR maintenance.

Conclusions:

• Shorter duration of persistent atrial fibrillation is a significant predictor of successful long-term sinus rhythm maintenance after ablation.
• Left atrial voltage mapping, specifically higher voltages, is crucial for predicting the success of single-ablation procedures for persistent AF.
• These findings can help refine patient selection and procedural strategies for AF ablation.