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Very long term outcome after linear versus electrogram guided ablation for persistent atrial fibrillation.

Seigo Yamashita1, Michifumi Tokuda2, Saagar Mahida3

  • 1Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan. seigoy722@yahoo.co.jp.

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|December 9, 2021
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Summary

Linear ablation combined with pulmonary vein isolation (PVI) offers superior long-term success for persistent atrial fibrillation (PsAF) compared to electrogram (EGM)-guided ablation. This strategy leads to better arrhythmia-free survival after procedures for PsAF patients.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • The optimal ablation strategy for persistent atrial fibrillation (PsAF) is not definitively established.
  • Pulmonary vein isolation (PVI) is a cornerstone of AF ablation, but additional strategies are often needed for PsAF.

Purpose of the Study:

  • To compare very long-term outcomes of linear ablation versus electrogram (EGM)-guided ablation as adjunctive therapy to PVI for PsAF.
  • To identify predictors of atrial arrhythmia recurrence after ablation for PsAF.

Main Methods:

  • Retrospective analysis of two propensity-score matched cohorts undergoing PVI for PsAF.
  • Cohort 1: PVI with linear ablation (roof/mitral isthmus lines). Cohort 2: PVI with EGM-guided ablation.
  • Comparison of arrhythmia-free survival over a mean follow-up of 100 months.

Main Results:

  • Linear ablation achieved significantly superior arrhythmia-free survival compared to EGM-guided ablation after initial and last procedures (Logrank p=0.0001 and p=0.045).
  • Complete block was achieved in 75% of patients receiving linear ablation (both lines).
  • Longer AF duration and EGM-guided ablation were independent predictors of atrial arrhythmia recurrence.

Conclusions:

  • Linear ablation may be a more effective complementary technique to PVI than EGM-guided ablation for treating PsAF.
  • This finding suggests a potential shift in optimal ablation strategies for complex PsAF cases.