• Arch Cardiovasc Dis · Oct 2013

    Multicenter Study Comparative Study

    Persistent atrial fibrillation presenting in sinus rhythm: pulmonary vein isolation versus pulmonary vein isolation plus electrogram-guided ablation.

    • Frederic A Sebag, Najia Chaachoui, Nick W Linton, Sana Amraoui, James Harrison, Steven Williams, Aldo C Rinaldi, Jaswinder Gill, Michael Cooklin, Senthil Kirubakaran, Mark D O'Neill, Matthew Wright, and Nicolas Lellouche.
    • Division of Cardiovascular Medicine, St. Thomas' Hospital, London, UK; The Rayne Institute, King's College London, London, UK; Fédération de Cardiologie, Hôpital Henri-Mondor, AP-HP et Inserm U 955, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94000 Creteil, France.
    • Arch Cardiovasc Dis. 2013 Oct 1; 106 (10): 501-10.

    BackgroundThe classification of atrial fibrillation as paroxysmal or persistent (PsAF) is clinically useful, but does not accurately reflect the underlying pathophysiology and is therefore a suboptimal guide to selection of ablation strategy.AimTo determine if additional substrate ablation is beneficial for a subset of patients with PsAF, in whom long periods of sinus rhythm (SR) can be maintained.MethodsWe included patients presenting with PsAF in whom continuous periods of SR>3months were documented. All patients were in SR on the day of the procedure. Electrical pulmonary vein isolation (PVI) was performed in all patients. Additional electrogram (EGM)-guided ablation was left to the discretion of the operator. Patient characteristics and follow-up were analysed with respect to presence or absence of additional EGM-guided ablation.ResultsSixty-five patients (mean age 60.1±8.9years; 81.5% men) met the inclusion criteria. EGM-guided ablation was performed in 32 (49%) patients. Patients with and without EGM-guided ablation had similar baseline characteristics. Absence of EGM-guided ablation was one of the independent predictors for arrhythmia recurrences after the index procedure (hazard ratio 0.24; confidence interval 0.12-0.47). After a median follow-up of 18±10months, the number of procedures required was significantly higher in the 'PVI-only' group (2.24±0.75 vs. 1.84±0.81; P=0.04) to achieve a similar success rate (84% vs. 81%; P=0.833).ConclusionThe addition of EGM-guided ablation requires fewer procedures to achieve similar clinical efficacy in mid-term follow-up compared with a PVI-only strategy in patients with PsAF presenting for ablation in SR.Copyright © 2013. Published by Elsevier Masson SAS.

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