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 |
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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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