Long-term outcomes of catheter ablation in patients with longstanding persistent atrial fibrillation lasting less than 2 years

被引:16
|
作者
Della Rocca, Domenico G. [1 ,2 ]
Mohanty, Sanghamitra [1 ]
Mohanty, Prasant [1 ]
Trivedi, Chintan [1 ]
Gianni, Carola [1 ]
Al-Ahmad, Amin [1 ]
Burkhardt, J. David [1 ]
Gallinghouse, G. Joseph [1 ]
Hranitzky, Patrick [1 ]
Sanchez, Javier E. [1 ]
Horton, Rodney P. [1 ]
Di Biase, Luigi [1 ,3 ,4 ]
Natale, Andrea [1 ,5 ,6 ,7 ,8 ]
机构
[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, 3000 North 1-35,Suite 720, Austin, TX 78705 USA
[2] Univ Tor Vergata, Dept Cardiovasc Med, Rome, Italy
[3] Montefiore Med Ctr, Albert Einstein Coll Med, Dept Med, Arrhythmia Serv, Bronx, NY 10467 USA
[4] Univ Foggia, Dept Clin & Expt Med, Foggia, Italy
[5] Scripps Clin, Intervent Electrophysiol, La Jolla, CA 92037 USA
[6] Case Western Reserve Univ, Metrohlth Med Ctr, Sch Med, Dept Cardiol, Cleveland, OH USA
[7] Stanford Univ, Div Cardiol, Stanford, CA 94305 USA
[8] Calif Pacific Med Ctr, Atrial Fibrillat & Arrhythmia Ctr, San Francisco, CA USA
关键词
atrial fibrillation; catheter ablation; empirical isolation; longstanding persistent; non-pulmonary vein triggers; PULMONARY VEIN ISOLATION; SUPERIOR VENA-CAVA; PERMANENT; PROGRESSION; APPENDAGE; AF;
D O I
10.1111/jce.13721
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Outcome data after catheter ablation (CA) for longstanding persistent atrial fibrillation (LSPAF) lasting less than 2 years are limited and highly variable with different ablation approaches. We aimed to assess the long-term outcomes in patients with LSPAF lasting less than 2 years undergoing extended pulmonary vein antrum isolation (PVAI) versus those with additional non-pulmonary vein (PV) trigger ablation. Methods and Results: In this prospective analysis, 381 consecutive patients with LSPAF lasting less than 2 years (age: 64 +/- 9 years, 76% male, atrial fibrillation duration: 19 +/- 5 months) undergoing their first CA were classified into two groups: Group 1 (n = 104) received PVAI extended to PW plus isolation of superior vena cava (SVC) and Group 2 (n = 277) received PVAI + PW+ SVC + non-PV-trigger ablation. All patients were followed-up for at least 2 years. In case of recurrence, repeat procedure was offered and non-PV triggers were targeted for ablation in all. After a single procedure, 26 (25%) patients in Group 1 and 172 (62.1%) in Group 2 remained arrhythmia-free (P < 0.001). A second procedure was performed in 58 of 78 (74.4%) patients in Group 1 and 77 of 105 (73.3%) patients in Group 2. Non-PV triggers were identified in 52 (89.6%) and 54 (70.1%) patients in Groups 1 and 2, respectively, and targeted for ablation. Overall, 72 (69.2%) patients in Group 1 and 238 (86%) in Group 2 remained arrhythmia-free (P < 0.001). Conclusion: In patients with LSPAF lasting less than 2 years, extended PVAI plus SVC isolation was less likely to achieve long-term sinus rhythm. In the majority of patients, recurrence was due to non-PV triggers and ablation of those resulted in better outcome.
引用
收藏
页码:1607 / 1615
页数:9
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