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Use of preprocedural multidetector computed tomography to decrease atrial fibrillation recurrence following extensive

Yuko Makita1, Yukiko Nakano, Noboru Oda

  • 1Department of Cardiovascular Medicine, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan. yuko7@hiroshima-u.ac.jp

Journal of Cardiology
|June 5, 2012
PubMed
Summary

Modifying ablation strategies based on pulmonary vein-left atrial appendage ridge thickness improved atrial fibrillation (AF) recurrence outcomes. Extended ablation at thicker ridges significantly reduced AF recurrence post-pulmonary vein isolation.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • The ridge between the left pulmonary vein (PV) and left atrial appendage (LAA) is notably thick.
  • Preprocedural multidetector computed tomography (MDCT) can assess PV-LAA ridge thickness.

Purpose of the Study:

  • To determine if tailoring ablation strategies to PV-LAA ridge thickness, identified by MDCT, impacts atrial fibrillation (AF) ablation outcomes.

Main Methods:

  • 110 patients undergoing extensive encircling circumferential pulmonary vein isolation (EEPVI) were divided into nonmodulation and modulation groups.
  • In the modulation group, ablation was extended at the PV-LAA ridge (>4.0 mm thickness on MDCT).

Main Results:

  • Extended ablation at the PV-LAA ridge was performed in 37 patients.
  • The modulation group showed significantly lower recurrence rates (10%) compared to the nonmodulation group (28%) after 25±9 months follow-up (p=0.018).
  • Modified ablation time and left atrium volume index were independent predictors of successful ablation.

Conclusions:

  • Adjusting ablation time at the PV-LAA ridge can decrease recurrence rates after EEPVI.
  • MDCT-guided ablation modulation is a promising strategy for improving AF treatment outcomes.