Challenging Achievement of Bidirectional Block After Linear Ablation Affects the Rhythm Outcome in Patients With Persistent Atrial Fibrillation

Autor: Junbeom Park, Hui Nam Pak, Jae Sun Uhm, Boyoung Joung, Jong Youn Kim, Moon Hyoung Lee, Tae Hoon Kim
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Catheter ablation
030204 cardiovascular system & hematology
posterior wall isolation
Pulmonary vein
linear ablation
Lesion
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Recurrence
Internal medicine
Atrial Fibrillation
catheter ablation
medicine
Humans
Arrhythmia and Electrophysiology
030212 general & internal medicine
Atrial tachycardia
Aged
Proportional Hazards Models
Original Research
Proportional hazards model
business.industry
Hazard ratio
Atrial fibrillation
Middle Aged
medicine.disease
Ablation
Prognosis
Logistic Models
Treatment Outcome
Pulmonary Veins
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Electrophysiologic Techniques
Cardiac
Catheter Ablation and Implantable Cardioverter-Defibrillator
Follow-Up Studies
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background It is not clear whether bidirectional block ( BDB ) of linear ablations reduces atrial fibrillation ( AF ) recurrence after radiofrequency catheter ablation. We hypothesized that BDB of linear ablation has prognostic significance after radiofrequency catheter ablation for persistent AF . Methods and Results Among 1793 consecutive patients in the Yonsei AF ablation cohort, this observational cohort study included 398 patients with persistent AF (75.6% male; age, 59.8±10.3 years) who underwent catheter ablation with a consistent ablation protocol of the Dallas lesion set: circumferential pulmonary vein isolation; cavotricuspid isthmus ablation ( CTI ); roof line ( RL ); posterior‐inferior line ( PIL ); and anterior line ( AL ). BDB rates of de novo ablation lines were 100% in circumferential pulmonary vein isolation, 100% in CTI , 84.7% in RL , 44.7% in PIL , and 63.6% in AL . During 29.0±18.4 months of follow‐up, 31.7% (126/398) of the patients showed clinical recurrence. Left atrial posterior wall ( LAPW ) isolation ( BDB s of RL and PIL ) was independently associated with lower clinical AF /atrial tachycardia recurrence (hazard ratio, 0.68; 95% CI, 0.47–0.98; P =0.041; log‐rank, P =0.017), whereas BDB s of RL or AL were not (log‐rank, P =0.178 for RL; P =0.764 for AL ). Among 52 patients who underwent repeat procedures (23.0±16.1 months after de novo procedure), the BDB maintenance rates for CTI , RL , PIL , and AL were 94.2% (49 of 52), 63.5% (33 of 47), 62.1% (18 of 29), and 61.8% (21 of 34), respectively. Conclusions Although PIL crosses the esophageal contact area, LAPW isolation is important for better clinical outcome in catheter ablation with a linear ablation strategy for patients with persistent AF.
Databáze: OpenAIRE
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