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- Title
Long-Term Outcome of Left Atrial Voltage-Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy.
- Authors
YAGISHITA, ATSUHIKO; GIMBEL, J. ROD; OLIVEIRA, SAMER; MANYAM, HARISH; SPARANO, DINA; CAKULEV, IVAN; MACKALL, JUDITH; ARRUDA, MAURICIO
- Abstract
Voltage-Guided Atrial Fibrillation Substrate Ablation Introduction Left atrium (LA) low voltage area (LVA) on 3-D electroanatomic bipolar voltage mapping (EAVM), as a surrogate for scar, is associated with poor AF ablation outcome. We evaluated the long-term outcome of an LVA-guided atrial fibrillation (AF) substrate modification strategy as an adjunct to pulmonary vein isolation (PVI). Methods and Results Two hundred and one consecutive patients with AF (82% persistent/Non-PAF, age 65 years), who underwent EAVM during AF prior to PVI, were divided into 2 groups according to the presence or absence of LVA outside the PV antra, defined as bipolar voltage of <0.5 mV. LVA-guided substrate modification was performed after PVI in patients with LVA. LVA was found in 159 patients (79%). Non-PAF (OR 3.851, P = 0.002) and CHA2DS2-VAS c score (OR 1.815, P < 0.001) were independent predictors for the LVA. After the index procedure, 144 patients (72%) were free from AF at 12 months. With multiple procedures, 148 patients (74%) during a median follow-up of 3.1 years were free from the recurrence. There was no difference in the recurrence (log-rank P = 0.746), and complications (0% vs. 7%, P = 0.125) between the groups. Neither LVA nor Non-PAF was an independent predictor for the recurrence in a multivariate analysis. Conclusions Patients with LVA had an equally favorable long-term ablation outcome compared to those without. As an adjunct to PVI, voltage-guided substrate modification may be an important ablation strategy in patients with LA structural remodeling.
- Subjects
ACTION potentials; ATRIAL fibrillation; CARDIOVASCULAR diseases; CATHETER ablation; CHI-squared test; FISHER exact test; HEART atrium; HEART beat; HEART conduction system; MULTIVARIATE analysis; PULMONARY veins; STATISTICAL hypothesis testing; T-test (Statistics); DISEASE relapse; LOGISTIC regression analysis; TREATMENT effectiveness; PROPORTIONAL hazards models; DATA analysis software; KAPLAN-Meier estimator; LOG-rank test; MANN Whitney U Test
- Publication
Journal of Cardiovascular Electrophysiology, 2017, Vol 28, Issue 2, p147
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.13122