Effect of Combined Pulmonary Vein and Superior Vena Cava Isolation on the Outcome of Second Catheter Ablation for Paroxysmal Atrial Fibrillation
| Autor: | Hua Zhao, Yunlong Wang, Zhuo Liang, Yongquan Wu, Xuejun Ren, Tao Zhang, Ye Wang, Zhi-hong Han |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Vena Cava Superior Isolation (health care) Paroxysmal atrial fibrillation Radiofrequency ablation medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology Pulmonary vein law.invention 03 medical and health sciences Electrocardiography 0302 clinical medicine Superior vena cava law Recurrence Internal medicine Atrial Fibrillation medicine Humans 030212 general & internal medicine Aged Retrospective Studies business.industry Electrical potentials Middle Aged Ablation Pulmonary Veins Cardiology Catheter Ablation Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The American journal of cardiology. 125(12) |
| ISSN: | 1879-1913 |
| Popis: | Recurrence of paroxysmal atrial fibrillation (AF) is partly due to pulmonary vein (PV) reconnection and non-PV foci, especially superior vena cava (SVC). We aimed to investigate the efficacy and safety of empiric SVC isolation plus PV isolation after first failed radiofrequency ablation involving only PV isolation for paroxysmal AF. Procedural and follow-up outcomes of ablation for 144 consecutive paroxysmal AF patients after first failed radiofrequency ablation involving only PV isolation were retrospectively compared between patients undergoing either conventional SVC isolation (additional SVC isolation if SVC-triggered AF or rapid SVC activity was observed; n = 72) or empiric SVC isolation after PV isolation (n = 72). In conventional SVC isolation versus empiric SVC isolation groups: baseline characteristics and proportion of recorded PV electrical potentials were similarly distributed and all pulmonary veins were successfully reisolated; SVC isolation was performed less often (6 [8.3%] vs 70 [97.2%]; p0.001, respectively); and during 19 ± 10 months follow-up, atrial tachyarrhythmias recurrence-free rate after a second procedure was lower (58.3% vs 77.8%, log rank; p = 0.037). Multivariate regression analysis revealed LA diameter ≥45 mm (odds ratio [OR] = 2.5; 95% confidence interval [CI], 1.4 to 4.6; p = 0.002) as the independent risk factor of atrial tachyarrhythmias recurrence and empiric SVC isolation (OR = 0.47; 95% CI, 0.25 to 0.87; p = 0.016) as the independent protector against atrial tachyarrhythmias recurrence after a second ablation procedure. Empiric SVC isolation plus PV isolation did not increase significantly procedural time or complications. In conclusion, the strategy of empiric SVC isolation plus PV isolation during a second procedure for paroxysmal AF improved atrial tachyarrhythmias recurrence-free rate without increasing procedural time or complications. |
| Databáze: | OpenAIRE |
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