Very long term outcome after linear versus electrogram guided ablation for persistent atrial fibrillation

Seigo Yamashita,Ryota Isogai,Hidenori Sato,Michifumi Tokuda,Ryohsuke Narui,Shin-Ichi Tanigawa,Michihiro Yoshimura,Kenichi Yokoyama,Hirotsuna Oseto,Kenichi Tokutake,Mika Kato,Teiichi Yamane,Masaaki Yokoyama,Saagar Mahida,Hirotsugu Ikewaki,Ken-Ichi Sugimoto

doi:10.1038/s41598-021-02935-3

Abstract

The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n = 52) and one with PVI and EGM-guided ablation (EGM-group; n = 52). Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p = 0.76). During 100 ± 28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8 ± 0.9 procedures) compared with EGM-group (Logrank test: p = 0.0001 and p = 0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of atrial arrhythmia recurrence. Linear ablation might be a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.

Highlights

The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined
The average minimum continuous AF duration was 15 ± 20 months. 29 (28%) had PsAF lasting between 6 months and 1 year while 43 (41%) had PsAF for > 1 year
Using a propensity score-matched analysis, we demonstrated superiority of linear ablation to EGM-guided ablation following single and multiple procedures

Summary

Introduction

The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. Long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n = 52) and one with PVI and EGM-guided ablation (EGM-group; n = 52). While pulmonary vein isolation (PVI) is associated with high success rates in patients with paroxysmal atrial fibrillation (PAF)[1,2,3,4], ablation outcomes in patients with persistent AF (PsAF) are more modest. In patients with PsAF, additional substrate-based AF ablation strategies have demonstrated potential benefit in a previous metaanalysis of controlled studies[5]. In a previous multicenter randomized trial, additional AF substrate ablation (roof and MI lines or complex fractionated atrial electrogram [CFAE] or EGMguided) beyond PVI for PsAF was not associated with incremental benefit compared to PVI alone. In the present study we compared very longterm clinical outcomes of linear ablation and EGM-guided ablation

Methods

Results

Conclusion