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

Research output: Contribution to journalArticle

Frederic A Sebag, Najia Chaachoui, Nick W Linton, Sana Amraoui, James Harrison, Steven Williams, Christopher Aldo Rinaldi, Jaswinder Gill, Michael Cooklin, Senthil Kirubakaran, Mark D O'Neill, Matthew Wright, Nicolas Lellouche

Original languageEnglish
Pages (from-to)501-510
Number of pages10
JournalArchives of cardiovascular diseases
Volume106
Issue number10
DOIs
PublishedOct 2013

King's Authors

Abstract

Background
The 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.

Aim
To 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.

Methods
We included patients presenting with PsAF in whom continuous periods of SR > 3 months 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.

Results
Sixty-five patients (mean age 60.1 ± 8.9 years; 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 ± 10 months, 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).

Conclusion
The 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.

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