Efficacy of an Adjunctive Electrophysiological Test-Guided Left Atrial Posterior Wall Isolation in Persistent Atrial Fibrillation Without a Left Atrial Low-Voltage Area
| Autor: | Takashi Murakami, Masaaki Murakami, Shigeshi Kamikawa, Shozo Kusachi, Satoshi Hirohata, Hirosuke Yamaji, Shunichi Higashiya, Hiroshi Kawamura, Kazuyoshi Hina |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Tachycardia
Male medicine.medical_specialty Time Factors medicine.medical_treatment Action Potentials Catheter ablation Pilot Projects 030204 cardiovascular system & hematology Pulmonary vein 03 medical and health sciences 0302 clinical medicine Posterior wall Japan Left atrial Heart Rate Predictive Value of Tests Recurrence Physiology (medical) Internal medicine Atrial Fibrillation medicine Humans 030212 general & internal medicine Heart Atria Aged business.industry Atrial fibrillation Atrial Remodeling Middle Aged medicine.disease Ablation Electrophysiology Treatment Outcome Pulmonary Veins Cardiology Catheter Ablation Atrial Function Left Female medicine.symptom Cardiology and Cardiovascular Medicine business Electrophysiologic Techniques Cardiac |
| Zdroj: | Circulation. Arrhythmia and electrophysiology. 13(8) |
| ISSN: | 1941-3084 |
| Popis: | Background: Electrical remodeling precedes structural remodeling. In adjunctive left atrial (LA) low-voltage area (LVA) ablation to pulmonary vein isolation of atrial fibrillation (AF), LA areas without LVA have not been targeted for ablation. We studied the effect of adjunctive LA posterior wall isolation (PWI) on persistent AF without LA-LVA according to electrophysiological testing (EP test). Methods: We examined consecutive patients with persistent AF with (n=33) and without (n=111) LA-LVA. Patients without LA-LVA were randomly assigned to EP test–guided (n=57) and control (n=54) groups. In the EP test–guided group, an adjunctive PWI was performed in those with positive results (PWI subgroup; n=24), but not in those with negative results (n=33). The criteria for positive EP tests were an effective refractory period ≤180 ms, effective refractory period>20 ms shorter than the other sites, and/or induction of AF/atrial tachycardia (AT) during measurements. LVA ablation was performed in the patients with LA-LVA. Results: During the follow-up period (62±33 weeks), the EP test–guided group had significantly lower recurrence rates (19%,11/57 versus 41%, 22/54, P =0.012) and higher Kaplan-Meier AF/AT–free survival curve rates than the control group ( P =0.01). No significant differences in the recurrence and AF/AT–free survival curve rates between the PWI (positive EP test) and non-PWI (negative EP test) subgroups were observed. Therefore, PWI for positive EP tests reduced the AF/AT recurrence in the EP test–guided group. A stepwise Cox proportional hazard analyses identified EP test–guided ablation as a factor reducing the recurrence rate. The recurrence rates in the LA-LVA ablation group and EP test–guided group were similar. Conclusions: This pilot study proposed that an EP test–guided adjunctive PWI of persistent AF without LA-LVA potentially reduced AF/AT recurrences. The results suggest that there is an AF substrate in the LA with altered electrophysiological function even when there is no LA-LVA. Graphic Abstract: A graphic abstract is available for this article. |
| Databáze: | OpenAIRE |
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