TY - JOUR
T1 - Pulmonary vein activity does not predict the outcome of catheter ablation for persistent atrial fibrillation
T2 - A long-term multicenter prospective study
AU - Prabhu, Sandeep
AU - Kalla, Manish
AU - Peck, Kah Y.
AU - Voskoboinik, Aleksandr
AU - McLellan, Alex J.A.
AU - Pathik, Bupesh
AU - Nalliah, Chrishan J.
AU - Wong, Geoff R.
AU - Sugumar, Hariharan
AU - Azzopardi, Sonia M.
AU - Lee, Geoffrey
AU - Ling, Liang Han
AU - Kalman, Jonathan M.
AU - Kistler, Peter M.
N1 - Funding Information:
This work was supported in part by the Victorian Government's Operational Infrastructure Funding.
Funding Information:
Dr Kistler has received funding from St. Jude Medical for consultancy and speaking engagements. Dr Kalman has received research and fellowship support from Medtronic, Biosense Webster, Boston Scientific, and Abbott and has received payment for advice to Biosense Webster. Dr Ling has received fellowship support from Medtronic, Biotronik, and St. Jude Medical. Dr Mclellan has received fellowship support from St. Jude Medical. Dr Sugumar has received fellowship support from St. Jude Medical and Medtronic. Dr Prabhu, Dr Ling, Dr McLellan, Dr Voskoboinik, Dr Nalliah, and Dr Pathik have received funding from the National Health and Medical Research Council, the National Heart Foundation of Australia, and/or the Baker Heart and Diabetes Research Institute. Dr Kalman, Dr Lee, and Dr Kistler are in part supported by the National Health and Medical Research Council.
Publisher Copyright:
© 2018 Heart Rhythm Society
PY - 2018/7
Y1 - 2018/7
N2 - Background: Pulmonary vein (PV) isolation (PVI) remains the cornerstone of catheter ablation (CA) in persistent atrial fibrillation (AF) (PeAF), although less successful than for paroxysmal AF. Whether rapid or fibrillatory (PV AF) PV firing may identify patients with PeAF more likely to benefit from a PV-based ablation approach is unclear. Objective: The purpose of this study was to determine the relationship between the PV cycle length (PVCL) and the PV AF outcome after CA. Methods: Before ablation, the multipolar catheter was placed in each PV and the left atrial appendage (LAA) for 100 consecutive cycles. The presence of PV AF, the average PVCL of all 4 veins (PV4VAverage), the fastest vein average (PVFVAverage), the fastest cycle length (PVFast) both individually and relative to the average LAA cycle length were calculated. The ablation strategy included PVI and posterior wall isolation with a minimum of 12 months follow-up. Results: A total of 123 patients underwent CA (age 62 ± 9.1 years; CHA2DS2-VASC score 1.6 ± 1.1; left ventricular ejection fraction 48% ± 13%; left atrial area 31 ± 8.7 cm2; AF duration 16 ± 17 months). PVI was achieved in 100% of patients. Multiprocedure success (MPS; freedom from AF/atrial tachycardia episodes lasting >30 seconds) was achieved in 76% of patients at 24 ± 8.1 months of follow-up after 1.2 ± 0.4 procedures. PV activity was not associated with MPS either absolutely (PV4VAverage [MPS no vs yes: 178 ± 27 ms vs 177 ± 24 ms; P =.92], PVFVAverage [P =.69], or PVFast [P =.82]) or as a ratio relative to the LAA cycle length (PV4VAverage/LAA 1.05 ± 0.11 vs 1.06 ± 0.21; P =.87). The presence of PV AF (31% vs 47%; P =.13) did not predict MPS. Conclusion: The rapidity of PV firing or presence of fibrillation within the PV was not predictive of outcome of CA for PeAF. PV activity does not identify patients most likely to benefit from a PV-based ablation strategy.
AB - Background: Pulmonary vein (PV) isolation (PVI) remains the cornerstone of catheter ablation (CA) in persistent atrial fibrillation (AF) (PeAF), although less successful than for paroxysmal AF. Whether rapid or fibrillatory (PV AF) PV firing may identify patients with PeAF more likely to benefit from a PV-based ablation approach is unclear. Objective: The purpose of this study was to determine the relationship between the PV cycle length (PVCL) and the PV AF outcome after CA. Methods: Before ablation, the multipolar catheter was placed in each PV and the left atrial appendage (LAA) for 100 consecutive cycles. The presence of PV AF, the average PVCL of all 4 veins (PV4VAverage), the fastest vein average (PVFVAverage), the fastest cycle length (PVFast) both individually and relative to the average LAA cycle length were calculated. The ablation strategy included PVI and posterior wall isolation with a minimum of 12 months follow-up. Results: A total of 123 patients underwent CA (age 62 ± 9.1 years; CHA2DS2-VASC score 1.6 ± 1.1; left ventricular ejection fraction 48% ± 13%; left atrial area 31 ± 8.7 cm2; AF duration 16 ± 17 months). PVI was achieved in 100% of patients. Multiprocedure success (MPS; freedom from AF/atrial tachycardia episodes lasting >30 seconds) was achieved in 76% of patients at 24 ± 8.1 months of follow-up after 1.2 ± 0.4 procedures. PV activity was not associated with MPS either absolutely (PV4VAverage [MPS no vs yes: 178 ± 27 ms vs 177 ± 24 ms; P =.92], PVFVAverage [P =.69], or PVFast [P =.82]) or as a ratio relative to the LAA cycle length (PV4VAverage/LAA 1.05 ± 0.11 vs 1.06 ± 0.21; P =.87). The presence of PV AF (31% vs 47%; P =.13) did not predict MPS. Conclusion: The rapidity of PV firing or presence of fibrillation within the PV was not predictive of outcome of CA for PeAF. PV activity does not identify patients most likely to benefit from a PV-based ablation strategy.
KW - Catheter ablation
KW - Catheter ablation outcomes
KW - Persistent atrial fibrillation
KW - Pulmonary vein cycle length
KW - Pulmonary vein electrical activity
UR - http://www.scopus.com/inward/record.url?scp=85048734116&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2018.02.029
DO - 10.1016/j.hrthm.2018.02.029
M3 - Article
C2 - 29501669
AN - SCOPUS:85048734116
SN - 1547-5271
VL - 15
SP - 980
EP - 986
JO - Heart Rhythm
JF - Heart Rhythm
IS - 7
ER -