Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long-Standing Persistent Atrial...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Long-standing persistent atrial fibrillation (AF) often resists treatment with pulmonary vein isolation (PVI) alone.
• Identifying and targeting specific electrophysiological substrates is crucial for effective AF ablation.
• This study investigates advanced ablation techniques beyond conventional PVI.

Purpose of the Study:

• To compare the efficacy of catheter ablation targeting electrophysiological substrates versus conventional PVI.
• To evaluate AF recurrence rates and burden of premature atrial contractions (PACs) post-ablation.
• To identify predictors of successful ablation in long-standing persistent AF.

Main Methods:

• Retrospective study of 105 patients with long-standing persistent AF undergoing catheter ablation.
• Propensity score matching (n=38 each) to compare conventional PVI with substrate-targeted ablation (AF drivers and fragmented potentials).
• Primary endpoint: AF recurrence >30s at ≥3 months post-ablation; secondary endpoints included PAC burden.

Main Results:

• Substrate-targeted ablation (driver and fragmented potentials group) had longer procedure times but showed a trend toward lower AF recurrence (21.1% vs. 36.8%).
• Significantly fewer post-ablation premature atrial contractions (PACs) were observed in the substrate-targeted group (p < 0.01).
• Fragmented potentials and driver activity in the left atrium's bottom region were independent predictors of AF recurrence (p=0.02).

Conclusions:

• Catheter ablation targeting atrial drivers and fragmented potentials shows promise for improved outcomes in long-standing persistent AF.
• This approach may reduce AF recurrence and PAC burden compared to conventional PVI.
• The bottom region of the left atrium is a key therapeutic target for enhancing long-term success in AF ablation.