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- Title
Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3‐year follow‐up outcomes.
- Authors
Hsieh, Yu‐Cheng; Lin, Yenn‐Jiang; Lo, Men‐Tzung; Chen, Yun‐Yu; Lin, Chin‐Yu; Lin, Chen; Chung, Fa‐Po; Lo, Li‐Wei; Chang, Shih‐Lin; Chao, Tze‐Fan; Hu, Yu‐Feng; Tuan, Ta‐Chuan; Liao, Jo‐Nan; Wu, Cheng‐I; Liu, Chih‐Min; Vicera, Jennifer‐Jeanne B.; Chen, Chun‐Chao; Chin, Chye‐Gen; Lugtu, Isaiah C.; Chen, Shih‐Ann
- Abstract
Objectives: This study aimed to assess the comparative efficacy of four ablation strategies on the incidence rates of freedom from atrial fibrillation (AF) or atrial tachycardia (AT) through a 3‐year follow‐up in patients with persistent AF. Background: The optimal substrate modification strategies using catheter ablation for patients with persistent AF remain unclear. Methods: Patients with persistent AF were enrolled consecutively to undergo each of four ablation strategies: (a) Group 1 (Gp 1, n = 69), pulmonary vein isolation (PVI) plus rotor ablation assisted by similarity index and phase mapping; (b) Gp 2 (n = 75), PVI plus linear ablations at the left atrium; (c) Gp 3 (n = 42), PVI plus the elimination of complex fractionated atrial electrograms; (d) Gp 4 (n = 67), PVI only. Potential confounders were adjusted via a multivariate survival parametric model. Results: Baseline characteristics were similar across the four groups. At a follow‐up period of 34.9 ± 38.6 months, patients in Gp 1 showed the highest rate of freedom from AF compared with the other three groups (p =.002), while patients in Gp 3 and 4 showed lower rates of freedom from AT than those of the other two groups (p =.006). Independent predictors of recurrence of AF were the ablation strategy (p =.002) and left atrial diameter (LAD) (p =.01). Conclusion: In patients with persistent AF, a substrate modification strategy using rotor ablation assisted by similarity index and phase mapping provided a benefit for maintaining sinus rhythm compared with the other strategies. Both ablation strategy and baseline LAD predicted the 3‐year outcomes of freedom from AT/AF
- Subjects
MATHEMATICAL statistics; PARAMETERS (Statistics); MULTIVARIATE analysis; TIME; ATRIAL fibrillation; CATHETER ablation; RETROSPECTIVE studies; HEALTH outcome assessment; TREATMENT effectiveness; MATHEMATICAL variables; DISEASE relapse; HEART atrium; TACHYCARDIA; ELECTROCARDIOGRAPHY; SURVIVAL analysis (Biometry); DESCRIPTIVE statistics; PULMONARY veins; EVALUATION
- Publication
Journal of Cardiovascular Electrophysiology, 2021, Vol 32, Issue 6, p1561
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.15033