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Published on: May 26, 2015
Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation:
Yu-Cheng Hsieh1,2, Yenn-Jiang Lin2,3, Men-Tzung Lo4,5
1Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Insights
Rotor ablation guided by phase mapping significantly improved freedom from atrial fibrillation (AF) and atrial tachycardia (AT) over 3 years compared to other strategies in persistent AF patients. Ablation strategy and left atrial diameter predicted outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Optimal catheter ablation strategies for persistent atrial fibrillation (AF) remain under investigation.
- Substrate modification techniques are crucial for improving long-term outcomes in AF management.
Purpose of the Study:
- To compare the efficacy of four distinct catheter ablation strategies in patients with persistent AF.
- To assess the 3-year rates of freedom from AF or atrial tachycardia (AT) across different ablation approaches.
Main Methods:
- A consecutive cohort of persistent AF patients underwent one of four ablation strategies: PVI plus rotor ablation (Gp 1), PVI plus linear ablation (Gp 2), PVI plus complex fractionated atrial electrograms elimination (Gp 3), or PVI alone (Gp 4).
- Outcomes were evaluated over a 3-year follow-up period.
- Multivariate survival analysis was used to adjust for potential confounders.
Main Results:
- Group 1 (PVI + rotor ablation) demonstrated the highest rate of freedom from AF compared to the other groups (p=0.002).
- Groups 3 and 4 showed lower rates of freedom from AT compared to Groups 1 and 2 (p=0.006).
- Ablation strategy and baseline left atrial diameter were independent predictors of AF/AT recurrence.
Conclusions:
- Substrate modification using rotor ablation with similarity index and phase mapping offers a benefit in maintaining sinus rhythm for persistent AF patients.
- The choice of ablation strategy and baseline left atrial diameter are critical predictors of 3-year freedom from AF/AT.
Objectives:
This study aimed to assess the comparative efficacy of four ablation strategies on the incidence rates of freedom from atrial fibrillation (AF) or atrial tachycardia (AT) through a 3-year follow-up in patients with persistent AF.
Background:
The optimal substrate modification strategies using catheter ablation for patients with persistent AF remain unclear.
Methods:
Patients with persistent AF were enrolled consecutively to undergo each of four ablation strategies: (a) Group 1 (Gp 1, n = 69), pulmonary vein isolation (PVI) plus rotor ablation assisted by similarity index and phase mapping; (b) Gp 2 (n = 75), PVI plus linear ablations at the left atrium; (c) Gp 3 (n = 42), PVI plus the elimination of complex fractionated atrial electrograms; (d) Gp 4 (n = 67), PVI only. Potential confounders were adjusted via a multivariate survival parametric model.
Results:
Baseline characteristics were similar across the four groups. At a follow-up period of 34.9 ± 38.6 months, patients in Gp 1 showed the highest rate of freedom from AF compared with the other three groups (p = .002), while patients in Gp 3 and 4 showed lower rates of freedom from AT than those of the other two groups (p = .006). Independent predictors of recurrence of AF were the ablation strategy (p = .002) and left atrial diameter (LAD) (p = .01).
Conclusion:
In patients with persistent AF, a substrate modification strategy using rotor ablation assisted by similarity index and phase mapping provided a benefit for maintaining sinus rhythm compared with the other strategies. Both ablation strategy and baseline LAD predicted the 3-year outcomes of freedom from AT/AF.
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