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One-year outcomes after pulmonary vein isolation plus posterior wall isolation and additional non-pulmonary vein trigger ablation for persistent atrial fibrillation with or without contact force sensing: a propensity score-matched comparison.

Authors
  • Takamiya, Tomomasa1
  • Nitta, Junichi2
  • Inaba, Osamu3
  • Sato, Akira3
  • Ikenouchi, Takashi3
  • Murata, Kazuya3
  • Inamura, Yukihiro3
  • Takahashi, Yoshihide4
  • Goya, Masahiko4
  • Hirao, Kenzo4
  • 1 Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintosin, Chuo-ku, Saitama-shi, Saitama, 330-8553, Japan. [email protected] , (Japan)
  • 2 Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan. , (Japan)
  • 3 Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintosin, Chuo-ku, Saitama-shi, Saitama, 330-8553, Japan. , (Japan)
  • 4 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyou-ku, Tokyo, 113-8510, Japan. , (Japan)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Dec 01, 2020
Volume
59
Issue
3
Pages
585–593
Identifiers
DOI: 10.1007/s10840-019-00700-1
PMID: 31907832
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Whether or not pulmonary vein isolation (PVI) plus left atrial posterior wall isolation (PWI) using contact force (CF) sensing improves the ablation outcome for persistent atrial fibrillation (AF) is unclear. This study compared the outcome of PVI plus PWI and additional non-PV trigger ablation for persistent AF with/without CF sensing. This retrospective cohort study analyzed 148 propensity score-matched persistent AF patients (median duration of persistent AF, 8 months (interquartile range, 3-24 months); left atrial diameter, 43 ± 7 mm) undergoing PVI plus PWI and ablation of non-PV triggers provoked by high-dose isoproterenol, including 74 with CF-sensing catheters (CF group) and 74 with conventional catheters (non-CF group). PVI plus PWI with no additional ablation but cavotricuspid isthmus ablation was performed without non-PV triggers in 48 CF patients (65%) and 54 non-CF patients (73%) (P = 0.38). In all other patients, we performed additional ablation of provoked non-PV triggers. The Kaplan-Meier estimate of the rate of freedom from atrial tachyarrhythmia recurrence off antiarrhythmic drugs at 12 months after the single procedure was higher in the CF group than in the non-CF group (85 vs. 70%, log-rank P = 0.030). A multivariable analysis revealed that using CF sensing and non-inducibility of AF from a non-PV trigger after PVI and PWI were significantly associated with a reduced rate of atrial tachyarrhythmia recurrence. Compared with non-CF sensing, PVI plus PWI and additional non-PV trigger ablation using CF-sensing catheters for persistent AF can reduce the rate of atrial tachyarrhythmia recurrence.

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