Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation

Claude S. Elayi, Luigi Di Biase, Conor Barrett, Chi Keong Ching, Moataz Al Aly, Maria Lucciola, Rong Bai, Rodney Horton, Tamer S. Fahmy, Atul Verma, Yaariv Khaykin, Jignesh Shah, Gustavo Morales, Richard Hongo, Steven Hao, Salwa Beheiry, Mauricio Arruda, Robert A. Schweikert, Jennifer Cummings, J. David BurkhardtPaul Wang, Amin Al-Ahmad, Bruno Cauchemez, Fiorenzo Gaita, Andrea Natale

Research output: Contribution to journalArticle

105 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1216-1223
Number of pages8
JournalHeart Rhythm
Volume7
Issue number9
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

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Keywords

  • Atrial fibrillation ablation
  • Atrial fibrillation termination
  • Complex fragmented atrial electrograms
  • Persistent atrial fibrillation
  • Pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Elayi, C. S., Di Biase, L., Barrett, C., Ching, C. K., Aly, M. A., Lucciola, M., Bai, R., Horton, R., Fahmy, T. S., Verma, A., Khaykin, Y., Shah, J., Morales, G., Hongo, R., Hao, S., Beheiry, S., Arruda, M., Schweikert, R. A., Cummings, J., ... Natale, A. (2010). Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation. Heart Rhythm, 7(9), 1216-1223. https://doi.org/10.1016/j.hrthm.2010.01.038