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- Title
Persistent Atrial Fibrillation Ablation Outcomes Stratified by Left Atrial Posterior Wall Isolation Lesion Set Features.
- Authors
Kogan, Edward V.; Knotts, Robert; Jankelson, Lior; Bernstein, Scott A.; Park, David S.; Holmes, Douglas; Aizer, Anthony; Chinitz, Larry A.; Barbhaiya, Chirag R.
- Abstract
Left atrial posterior wall (LAPW) isolation is associated with favorable outcomes for catheter ablation of persistent atrial fibrillation (PEAF); however, the optimal technique remains unclear. We hypothesized that LAPW isolations, which included higher internal ablation lesion densities with larger proportions of left atrium (LA) surface area electrical isolation, would result in increased rates of freedom from arrhythmia recurrence two years following the initial procedure. LAPW lesion density and surface area relative to total LA surface area were calculated using electroanatomic maps of 110 consecutive patients not on antiarrhythmic medications undergoing LAPW isolation for PEAF (CARTO 3, Biosense Webster, Inc.). LAPW isolation was performed at the discretion of 5 experienced operators after voltage mapping. LAPW pulmonary vein entrance and exit block were confirmed. Freedom from arrhythmia recurrence at two years was compared by Kaplan-Meier analysis. LAPW lesion density ranged from 0% to 99%. The proportion of LA surface area isolated ranged from 35% to 75%. There was no significant difference in arrhythmia-free survival stratified by median LAPW ablation density (31% vs 27%, P=0.8) or median proportion of electrically isolated LA surface area (31% vs 27%, P=0.8). Voltage map-guided LAPW isolation did not significantly increase freedom from arrhythmia recurrence (29% vs 28%, P=1). Neither the density of ablation within nor the dimensions of the LAPW isolated region predicted arrhythmia-free survival for catheter ablation of PEAF. Voltage map-guided LAPW isolation resulted in similar ablation efficacy regardless of LA scar burden.
- Subjects
CATHETER ablation; ATRIAL fibrillation; ARRHYTHMIA; PULMONARY veins; KAPLAN-Meier estimator
- Publication
Journal of Atrial Fibrillation & Electrophysiology, 2024, Vol 17, Issue 2, p6
- ISSN
2831-7335
- Publication type
Article