TY - JOUR
T1 - Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring
T2 - Comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation
AU - Mohanty, Sanghamitra
AU - Mohanty, Prasant
AU - Di Biase, Luigi
AU - Trivedi, Chintan
AU - Morris, Eli Hamilton
AU - Gianni, Carola
AU - Santangeli, Pasquale
AU - Bai, Rong
AU - Sanchez, Javier E.
AU - Hranitzky, Patrick
AU - Gallinghouse, G. Joseph
AU - Al-Ahmad, Amin
AU - Horton, Rodney P.
AU - Hongo, Richard
AU - Beheiry, Salwa
AU - Elayi, Claude S.
AU - Lakkireddy, Dhanunjaya
AU - Madhu Reddy, Yaruva
AU - Viles Gonzalez, Juan F.
AU - Burkhardt, J. David
AU - Natale, Andrea
N1 - Publisher Copyright:
© The Author 2016.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Left atrial (LF) tissue fibrosis is a hallmark of arrhythmogenic structural remodelling of the cardiac substrate in atrial fibrillation (AF).1 By providing the substrate needed for the persistence of AF, it is believed to impact the success of catheter ablation, one of the most effective rhythm control strategies in AF.1,2 Atrial fibrosis can be a pathological endpoint in several settings such as advanced age, genetic predisposition, myocardial ischemia, mitral valve disease, and mechanical overload of the heart.3,4 Interestingly, studies have shown similar degree of fibrosis in patients with and without history of AF.5 Therefore, the causal association between LA scar and AF occurrence and persistence still remains to be defined. After the seminal study by Haissaguerre et al. demonstrating pulmonary vein (PV) triggers initiating AF, PV isolation (PVI), and later PV antrum isolation (PVAI) have been widely performed in paroxysmal AF (PAF) patients with high success rate.6 However, based on results from multiple studies it is clear that PV triggers are not the only mechanism responsible for AF; PAF can be initiated by non-PV ectopic beats.7-9 Therefore, the clinical relevance of these non-PV drivers in influencing ablation-outcome cannot be undermined. Although PAF patients present with severe LA scar from time to time, very little data are available to guide in deciding for the best ablation strategy in this unique subset of AF population. Therefore, we aimed to compare the long-term outcome of three ablation approaches, namely PVAI only and PVAI combined with either scar homogenization or non-PV triggers ablation, in PAF patients with extensive LA scar.
AB - Left atrial (LF) tissue fibrosis is a hallmark of arrhythmogenic structural remodelling of the cardiac substrate in atrial fibrillation (AF).1 By providing the substrate needed for the persistence of AF, it is believed to impact the success of catheter ablation, one of the most effective rhythm control strategies in AF.1,2 Atrial fibrosis can be a pathological endpoint in several settings such as advanced age, genetic predisposition, myocardial ischemia, mitral valve disease, and mechanical overload of the heart.3,4 Interestingly, studies have shown similar degree of fibrosis in patients with and without history of AF.5 Therefore, the causal association between LA scar and AF occurrence and persistence still remains to be defined. After the seminal study by Haissaguerre et al. demonstrating pulmonary vein (PV) triggers initiating AF, PV isolation (PVI), and later PV antrum isolation (PVAI) have been widely performed in paroxysmal AF (PAF) patients with high success rate.6 However, based on results from multiple studies it is clear that PV triggers are not the only mechanism responsible for AF; PAF can be initiated by non-PV ectopic beats.7-9 Therefore, the clinical relevance of these non-PV drivers in influencing ablation-outcome cannot be undermined. Although PAF patients present with severe LA scar from time to time, very little data are available to guide in deciding for the best ablation strategy in this unique subset of AF population. Therefore, we aimed to compare the long-term outcome of three ablation approaches, namely PVAI only and PVAI combined with either scar homogenization or non-PV triggers ablation, in PAF patients with extensive LA scar.
KW - Left atrial scar
KW - Non-pulmonary vein triggers
KW - Paroxysmal atrial fibrillation
KW - Pulmonary vein antrum isolation
KW - Scar homogenization
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U2 - 10.1093/europace/euw338
DO - 10.1093/europace/euw338
M3 - Article
C2 - 28039211
AN - SCOPUS:85034816806
SN - 1099-5129
VL - 19
SP - 1790
EP - 1797
JO - Europace
JF - Europace
IS - 11
ER -