Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3-year follow-up outcomes

Yu Cheng Hsieh, Yenn Jiang Lin, Men Tzung Lo, Yun Yu Chen, Chin Yu Lin, Chen Lin, Fa Po Chung, Li Wei Lo, Shih Lin Chang, Tze Fan Chao, Yu Feng Hu, Ta Chuan Tuan, Jo Nan Liao, Cheng I. Wu, Chih Min Liu, Jennifer Jeanne B. Vicera, Chun Chao Chen, Chye Gen Chin, Isaiah C. Lugtu, Shih Ann Chen

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • atrial tachycardia
  • persistent atrial fibrillation
  • phase map
  • pulmonary vein isolation
  • similarity index
  • substrate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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