B-PO02-091 PULMONARY VEIN ISOLATION COMBINED WITH INTERCONNECTED SUBSTRATE-MODIFICATION GUIDED BY VOLTAGE MAPPING FOR PATIENTS WITH LONG-STANDING PERSISTENT ATRIAL FIBRILLATION

Abstract

Ablation for long-standing persistent atrial fibrillation (AF) (LsPeAF) currently has limited long-term success rates and has no preferred approach yet. To develop a strategy by pulmonary vein isolation (PVI) combined with interconnected substrate modification guided by voltage mapping. 170 LsPeAF patients with sustained AF after PVI were grouped randomly into substrate modification only (substrate-modified group, n=84) and substrate modification plus interconnected modified area to area and to anatomy barriers via shortest ablation lines (interconnected substrate-modified group, n=86). AF terminated in 31 of 86 patients in the interconnected substrate-modified group, and AF converted into AFL/AT in 18 patients, which were significantly different from the substrate-modified group in which 22 and 12 of the 84 patients. In the redo procedure, less recurrent AFL/AT were detected in patients with interconnected substrate-modified ablation (9/17 vs. 20/29) while recurrent AF was similar. After median 51 months follow-up, interconnected substrate-modified ablation had a significant higher overall success rate (73.8% vs. 51.2%), and a higher arrhythmia-free survival in Kaplan-Meier analysis (51.2%; odds ratio 2.23, p<0.05). In LsPeAF patients, the strategy with PVI combined with interconnected substrate-modified ablation using additional short ablation lines connecting the modified-substrate site to its neighbors and anatomic barriers according to individual mapping results, was superior to the substrate modification in achieving short and long-term freedom of arrhythmia.