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- Title
Long-Term Outcome of Three Different Ablation Strategies In Persistent and Long-Standing Persistent Atrial Fibrillation: Results From A Randomized Study (TANTRA).
- Authors
Mohanty, Sanghamitra; Casella, Michela; Mohanty, Prasant; Dello Russo, Antonio; Compagnucci, Paolo; Della Rocca, Domenico G.; Gianni, Carola; China, Paolo; Themistoclakis, Sakis; MacDonald, Bryan; Mayedo, Angel; Al-Ahmad, Amin; Horton, Rodney; Bassiouny, Mohamed; Gallinghouse, G.J.; Burkhardt, J.D.; Di Biase, Luigi; Tondo, Claudio; Natale, Andrea
- Abstract
Introduction: The limited success rate of conventional ablation approach including isolation of pulmonary veins (PVI) in non-paroxysmal AF has led to the search for alternative ablation strategies. In this study, we evaluated the outcome of three different ablation approaches for non-paroxysmal AF. Methods: Patients were randomly assigned to Group 1: PVI+ isolation of LA posterior wall (PWI), Group 2: PVI+ scar homogenization and Group 3: PVI+PWI+ ablation of sustained non-PV triggers. LA scar (<0.5 mV) was identified by 3-D voltage mapping in sinus rhythm. Freedom from arrhythmia recurrence at 1 year and acute procedure-success, defined as AF termination (organization to AT or conversion to sinus rhythm), were compared across the groups Results: A total of 62 patients were randomized to group 1: 22, group 2: 19 and group 3: 21. Eight (36.3%) in group 1 and 9 (47.3%) in group 2 failed to achieve acute procedural success and underwent PVI+PWI+NPV trigger ablation. Acute success was achieved in all (100%) group 3 patients. Acute procedure failure or recurrence of arrhythmia at 1 year was reported in 54.5% (12/22) in group 1, 68.4% (13/19) group 2 and 28.6% (6/21) in group 3. Compared to group 3, the combined failure rate was significantly higher in group 2 (Chi-Square p= 0.011, Odds ratio 5.42 (95% CI 1.40 to 20.97), p=0.014). Conclusion: In patients with non-paroxysmal AF, PVI+ scar homogenization was associated with significantly lower success rate compared to the ablation strategy targeting PV+ posterior wall +non-PV triggers.
- Subjects
CATHETER ablation; ATRIAL fibrillation; PULMONARY veins; DISEASE relapse; ARRHYTHMIA
- Publication
Journal of Atrial Fibrillation & Electrophysiology, 2022, Vol 15, Issue 4, p19
- ISSN
2831-7335
- Publication type
Article