TY - JOUR
T1 - Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation
T2 - Results from a multicenter study
AU - Bhargava, Mandeep
AU - Di Biase, Luigi
AU - Mohanty, Prasant
AU - Prasad, Subramanyam
AU - Martin, David O.
AU - Williams-Andrews, Michelle
AU - Wazni, Oussama M.
AU - Burkhardt, J. David
AU - Cummings, Jennifer E.
AU - Khaykin, Yaariv
AU - Verma, Atul
AU - Hao, Steven
AU - Beheiry, Salwa
AU - Hongo, Richard
AU - Rossillo, Antonio
AU - Raviele, Antonio
AU - Bonso, Aldo
AU - Themistoclakis, Sakis
AU - Stewart, Kelly
AU - Saliba, Walid I.
AU - Schweikert, Robert A.
AU - Natale, Andrea
PY - 2009/10
Y1 - 2009/10
N2 - Background/Objective: The purpose of this prospective multicenter study was to compare results of catheter ablation in patients with paroxysmal atrial fibrillation (PAF) and those with nonparoxysmal atrial fibrillation (NPAF). The impact and the role of repeat catheter ablation were assessed in patients with recurrence. Methods/Results: One thousand four hundred four patients underwent catheter ablation for atrial fibrillation (AF) performed by 12 operators at four institutions using a single technique guided by intracardiac echocardiography. Of these patients, 728 had PAF and 676 had NPAF. Among the NPAF patients, 293 had persistent AF and 383 had long-standing persistent AF. Patients with NPAF had a higher incidence of hypertension and/or structural heart disease (64.8% vs 48.5%, P = .003) and a lower mean left ventricular ejection fraction (53.3% ± 8.7% vs 55.7 ± 6.5%, P <.001). All patients underwent antral isolation of all four pulmonary veins and the superior vena cava. At mean follow-up of 57 ± 17 months, 565 of 728 patients with PAF and 454 of 676 patients with NPAF (77.6% vs 67.2%, P <.001) had freedom from AF after a single ablation procedure. For arrhythmia recurrences, 74.2% (121/163) patients with PAF and 74.8% (166/222) with NPAF underwent repeat ablation, after which 92.4% patients with PAF and 84.0% patients with NPAF remained free from AF. Conclusion: Pulmonary vein antrum isolation guided by intracardiac echocardiography results in significant freedom from AF, even when performed by multiple operators in different centers. At least moderate efficacy can be achieved in patients with NPAF, although the success rate is lower than in patients with PAF. Considerably higher success can be achieved in both groups with repeat ablation.
AB - Background/Objective: The purpose of this prospective multicenter study was to compare results of catheter ablation in patients with paroxysmal atrial fibrillation (PAF) and those with nonparoxysmal atrial fibrillation (NPAF). The impact and the role of repeat catheter ablation were assessed in patients with recurrence. Methods/Results: One thousand four hundred four patients underwent catheter ablation for atrial fibrillation (AF) performed by 12 operators at four institutions using a single technique guided by intracardiac echocardiography. Of these patients, 728 had PAF and 676 had NPAF. Among the NPAF patients, 293 had persistent AF and 383 had long-standing persistent AF. Patients with NPAF had a higher incidence of hypertension and/or structural heart disease (64.8% vs 48.5%, P = .003) and a lower mean left ventricular ejection fraction (53.3% ± 8.7% vs 55.7 ± 6.5%, P <.001). All patients underwent antral isolation of all four pulmonary veins and the superior vena cava. At mean follow-up of 57 ± 17 months, 565 of 728 patients with PAF and 454 of 676 patients with NPAF (77.6% vs 67.2%, P <.001) had freedom from AF after a single ablation procedure. For arrhythmia recurrences, 74.2% (121/163) patients with PAF and 74.8% (166/222) with NPAF underwent repeat ablation, after which 92.4% patients with PAF and 84.0% patients with NPAF remained free from AF. Conclusion: Pulmonary vein antrum isolation guided by intracardiac echocardiography results in significant freedom from AF, even when performed by multiple operators in different centers. At least moderate efficacy can be achieved in patients with NPAF, although the success rate is lower than in patients with PAF. Considerably higher success can be achieved in both groups with repeat ablation.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Nonparoxysmal
KW - long-standing persistent atrial fibrillation
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U2 - 10.1016/j.hrthm.2009.06.014
DO - 10.1016/j.hrthm.2009.06.014
M3 - Article
C2 - 19716348
AN - SCOPUS:74649083503
SN - 1547-5271
VL - 6
SP - 1403
EP - 1412
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -