TY - JOUR
T1 - Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation
AU - Elayi, Claude S.
AU - Di Biase, Luigi
AU - Barrett, Conor
AU - Ching, Chi Keong
AU - Aly, Moataz Al
AU - Lucciola, Maria
AU - Bai, Rong
AU - Horton, Rodney
AU - Fahmy, Tamer S.
AU - Verma, Atul
AU - Khaykin, Yaariv
AU - Shah, Jignesh
AU - Morales, Gustavo
AU - Hongo, Richard
AU - Hao, Steven
AU - Beheiry, Salwa
AU - Arruda, Mauricio
AU - Schweikert, Robert A.
AU - Cummings, Jennifer
AU - Burkhardt, J. David
AU - Wang, Paul
AU - Al-Ahmad, Amin
AU - Cauchemez, Bruno
AU - Gaita, Fiorenzo
AU - Natale, Andrea
PY - 2010/9
Y1 - 2010/9
N2 - Background: Ablation of long-standing persistent atrial fibrillation (AF) remains challenging, with a lower success rate than paroxysmal AF. A reliable ablation endpoint has not been demonstrated yet, although AF termination during ablation may be associated with higher long-term maintenance of sinus rhythm (SR). Objective: The purpose of this study was to determine whether the method of AF termination during ablation predicts mode of recurrence or long-term outcome. Methods: Three hundred six patients with long-standing persistent AF, free of antiarrhythmic drugs (AADs), undergoing a first radiofrequency ablation (pulmonary vein [PV] antrum isolation and complex fractionated atrial electrograms) were prospectively included. Organized atrial tachyarrhythmias (AT) that occurred during AF ablation were targeted. AF termination mode during ablation was studied in relation to other variables (characteristics of arrhythmia recurrence, redo procedures, the use of adenosine/isoproterenol for redo, and comparison of focal versus macroreentrant ATs). Long-term maintenance of SR was assessed during the follow-up. Results: During AF ablation, six of 306 patients converted directly to SR, 172 patients organized into AT (with 38 of them converting in SR with further ablation), and 128 did not organize or terminate and were cardioverted. Two hundred eleven of 306 patients (69%) maintained in long-term SR without AADs after a mean follow-up of 25 ± 6.9 months, with no statistical difference between the various AF termination modes during ablation. Presence or absence of organization during ablation clearly predicted the predominant mode of recurrence, respectively, AT or AF (P = .022). Among the 74 redo ablation patients, 24 patients (32%) had extra PV triggers revealed by adenosine/isoproterenol. Termination of focal ATs was correlated with higher long-term success rate (24/29, 83%) than termination of macroreentrant ATs (20/35, 57%; P = .026). Conclusion: AF termination during ablation (conversion to AT or SR) could predict the mode of arrhythmia recurrence (AT vs. AF) but did not impact the long-term SR maintenance after one or two procedures. AT termination with further ablation did not correlate with better long-term outcome, except with focal ATs, for which termination seems critical.
AB - Background: Ablation of long-standing persistent atrial fibrillation (AF) remains challenging, with a lower success rate than paroxysmal AF. A reliable ablation endpoint has not been demonstrated yet, although AF termination during ablation may be associated with higher long-term maintenance of sinus rhythm (SR). Objective: The purpose of this study was to determine whether the method of AF termination during ablation predicts mode of recurrence or long-term outcome. Methods: Three hundred six patients with long-standing persistent AF, free of antiarrhythmic drugs (AADs), undergoing a first radiofrequency ablation (pulmonary vein [PV] antrum isolation and complex fractionated atrial electrograms) were prospectively included. Organized atrial tachyarrhythmias (AT) that occurred during AF ablation were targeted. AF termination mode during ablation was studied in relation to other variables (characteristics of arrhythmia recurrence, redo procedures, the use of adenosine/isoproterenol for redo, and comparison of focal versus macroreentrant ATs). Long-term maintenance of SR was assessed during the follow-up. Results: During AF ablation, six of 306 patients converted directly to SR, 172 patients organized into AT (with 38 of them converting in SR with further ablation), and 128 did not organize or terminate and were cardioverted. Two hundred eleven of 306 patients (69%) maintained in long-term SR without AADs after a mean follow-up of 25 ± 6.9 months, with no statistical difference between the various AF termination modes during ablation. Presence or absence of organization during ablation clearly predicted the predominant mode of recurrence, respectively, AT or AF (P = .022). Among the 74 redo ablation patients, 24 patients (32%) had extra PV triggers revealed by adenosine/isoproterenol. Termination of focal ATs was correlated with higher long-term success rate (24/29, 83%) than termination of macroreentrant ATs (20/35, 57%; P = .026). Conclusion: AF termination during ablation (conversion to AT or SR) could predict the mode of arrhythmia recurrence (AT vs. AF) but did not impact the long-term SR maintenance after one or two procedures. AT termination with further ablation did not correlate with better long-term outcome, except with focal ATs, for which termination seems critical.
KW - Atrial fibrillation ablation
KW - Atrial fibrillation termination
KW - Complex fragmented atrial electrograms
KW - Persistent atrial fibrillation
KW - Pulmonary vein isolation
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U2 - 10.1016/j.hrthm.2010.01.038
DO - 10.1016/j.hrthm.2010.01.038
M3 - Article
C2 - 20206323
AN - SCOPUS:77956229544
SN - 1547-5271
VL - 7
SP - 1216
EP - 1223
JO - Heart Rhythm
JF - Heart Rhythm
IS - 9
ER -