PO-02-094 ALL PULMONARY VEIN ISOLATION STRATEGIES ARE EQUALLY EFFECTIVE IN REDUCING THE RECURRENCE OF ATRIAL ARRHYTHMIAS

Abstract

Ostial and antral pulmonary vein isolation techniques have different properties. In addition, there are differences between radiofrequency and cryoballoon ablation based on tissue contact characteristics. Finally, posterior wall isolation (PWI) has been proposed as an adjuvant to PVI because of embryological origin similarities. We examine the results of ostial and antral RF ablation, cryoballoon PVI and PWI adjunction in the DECAAF-II trial with regard to the recurrence of atrial arrhythmias after ablation. Patients with persistent AF from the DECAAF-II trial who underwent PVI only or PVI + PWI were included. All patients underwent LGE-MRI before ablation and 3 months after ablation. The electroanatomic maps at time of procedure displaying the location of ablation lesions were merged with baseline LGE-MRI images, and two reviewers analyzed and classified the resulting reconstructions. PVI were classified as ostial if the lesions were in the immediate proximity of the pulmonary veins’ ostium and as antral if the lesions included a portion of the antrum around the pulmonary veins. Patients with PVI + PWI were extracted as a separate group. Patients were followed up for a total of 18 months using daily single-lead smartphone ECG strips. The primary outcome of this analysis was recurrence of atrial arrhythmias after the 90-day blanking period. A total of 367 patients were considered for analysis. 211 patients underwent ostial PVI, 81 antral PVI, 31 had PVI + PWI, and 44 underwent cryoablation. Baseline characteristics were comparable in terms of age, sex, fibrosis percentage, comorbidity profile (hypertension, diabetes, hyperlipidemia, CAD, history of stroke), and medication history, except for a significant difference in history of heart failure (10.4% vs. 18.5% vs. 29% vs. 27.3%, p = 0.004) and prior AAD use (46.9% vs. 44.4% vs. 64.5% vs. 29.5%, p = 0.026). Recurrence rates were comparable among the four groups: 91 (43%) patients had recurrence in the ostial PVI group, 39 (48%) in the antral PVI group, 12 (39%) in the PWI group, and 22 (50%) in the cryoablation group (log rank P=0.76). In patients with persistent AF, all PVI techniques show equal efficacy in terms of atrial arrhythmia recurrence. Isolation of the posterior wall during ablation in persistent AF has no procedural advantage.