RT Journal Article
SR Electronic
T1 Ablation of complex fractionated electrograms improves outcome in long standing persistent atrial fibrillation
JF bioRxiv
FD Cold Spring Harbor Laboratory
SP 123463
DO 10.1101/123463
A1 Claire A Martin
A1 James P Curtain
A1 Parag R Gajendragadkar
A1 David A Begley
A1 Simon P Fynn
A1 Andrew A Grace
A1 Patrick M Heck
A1 Munmohan S Virdee
A1 Sharad Agarwal
YR 2017
UL http://biorxiv.org/content/early/2017/04/03/123463.abstract
AB Purpose There is controversy and sparse data on whether substrate based techniques in addition to pulmonary vein isolation (PVI) confer benefit in the catheter ablation of persistent atrial fibrillation (AF), especially if long standing. We performed an observational study to assess whether substrate based ablation improved freedom from atrial arrhythmia.Methods 286 patients undergoing first ablation procedures for persistent AF with PVI only, PVI plus linear ablation, or PVI plus complex fractionated electrogram (CFAE) and linear ablation were followed. Primary end point was freedom from atrial arrhythmia at one year.Results Mean duration of pre-procedure time in AF was 28+/-27 months. Freedom from atrial arrhythmia was higher with a PVI+CFAE+lines strategy then for PVI alone (HR 1.56, 95% CI: 1.04-2.34, p=0.032) but was not higher with PVI+lines. Benefit of substrate modification was conferred for pre-procedure times in AF of over 30 months. The occurrence of atrial tachycardia was higher when lines were added to the ablation strategy (HR 0.08, 95% CI: 0.01-0.59, p=0.014). Freedom from atrial arrhythmia at 1 year was higher with lower patient age, use of general anaesthetic (GA), normal or mildly dilated left atrium and decreasing time in AF.Conclusions In patients with long standing persistent AF of over 30 months duration, CFAE ablation resulted in improved freedom from atrial arrhythmia. Increased freedom from atrial arrhythmia occurs in patients who are younger and have smaller atria, and with GA procedures. Linear ablation did not improve outcome and resulted in a higher incidence of atrial tachycardia.