TY - JOUR
T1 - Importance of non-pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction
AU - Zhao, Yonghui
AU - Di Biase, Luigi
AU - Trivedi, Chintan
AU - Mohanty, Sanghamitra
AU - Bai, Rong
AU - Mohanty, Prasant
AU - Gianni, Carola
AU - Santangeli, Pasquale
AU - Horton, Rodney
AU - Sanchez, Javier
AU - Gallinghouse, G. Joseph
AU - Zagrodzky, Jason
AU - Hongo, Richard
AU - Beheiry, Salwa
AU - Lakkireddy, Dhanunjaya
AU - Reddy, Madhu
AU - Hranitzky, Patrick
AU - Al-Ahmad, Amin
AU - Elayi, Claude
AU - Burkhardt, J. David
AU - Natale, Andrea
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background Whether ablation of non-pulmonary vein (PV) triggers after pulmonary vein antrum isolation (PVAI) improves the long-term procedure outcome in patients with paroxysmal atrial fibrillation (PAF) and left ventricular systolic dysfunction is unknown. Objective We sought to evaluate whether a more extensive ablation procedure improves outcomes at follow-up. Methods Consecutive patients with PAF refractory to antiarrhythmic drugs presenting for PVAI were prospectively studied. Patients were categorized into 2 groups: patients with left ventricular ejection fraction (LVEF) ≤35% (group I; n = 175) and patients with LVEF ≥50% (group II; n = 545). Patients in group I were further divided according to whether additional ablation of non-PV triggers was performed (group IA; n = 88) or not (group IB; n = 87). Long-term ablation success off antiarrhythmic drugs after a single procedure was analyzed. Results Patients in group I had more non-PV triggers than did patients in group II (69.1% vs 26.6%; P <.001). During a follow-up of 15.8 ± 4.7 months, fewer patients in group I remained free from recurrences than those in group II (53.7% vs 81.7%; P <.001). Long-term ablation success was higher in group IA than in group IB (75.0% vs 32.2%; P <.001) and similar to that in group II (75.0% vs 81.7%; P =.44). In multivariate analysis, LVEF ≤35% (hazard ratio 1.68; P =.003) and non-PV triggers (hazard ratio 3.12; P <.001) were independent predictors of recurrences. Conclusion In patients with PAF and left ventricular systolic dysfunction, ablation of non-PV triggers in addition to PVAI significantly improves their long-term procedure outcome.
AB - Background Whether ablation of non-pulmonary vein (PV) triggers after pulmonary vein antrum isolation (PVAI) improves the long-term procedure outcome in patients with paroxysmal atrial fibrillation (PAF) and left ventricular systolic dysfunction is unknown. Objective We sought to evaluate whether a more extensive ablation procedure improves outcomes at follow-up. Methods Consecutive patients with PAF refractory to antiarrhythmic drugs presenting for PVAI were prospectively studied. Patients were categorized into 2 groups: patients with left ventricular ejection fraction (LVEF) ≤35% (group I; n = 175) and patients with LVEF ≥50% (group II; n = 545). Patients in group I were further divided according to whether additional ablation of non-PV triggers was performed (group IA; n = 88) or not (group IB; n = 87). Long-term ablation success off antiarrhythmic drugs after a single procedure was analyzed. Results Patients in group I had more non-PV triggers than did patients in group II (69.1% vs 26.6%; P <.001). During a follow-up of 15.8 ± 4.7 months, fewer patients in group I remained free from recurrences than those in group II (53.7% vs 81.7%; P <.001). Long-term ablation success was higher in group IA than in group IB (75.0% vs 32.2%; P <.001) and similar to that in group II (75.0% vs 81.7%; P =.44). In multivariate analysis, LVEF ≤35% (hazard ratio 1.68; P =.003) and non-PV triggers (hazard ratio 3.12; P <.001) were independent predictors of recurrences. Conclusion In patients with PAF and left ventricular systolic dysfunction, ablation of non-PV triggers in addition to PVAI significantly improves their long-term procedure outcome.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Ejection fraction
KW - Heart failure
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U2 - 10.1016/j.hrthm.2015.08.029
DO - 10.1016/j.hrthm.2015.08.029
M3 - Article
C2 - 26304713
AN - SCOPUS:84955471733
VL - 13
SP - 141
EP - 149
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 1
ER -