Left Linear Lesions Research Articles

Symptomatic and Asymptomatic Long‐Term Recurrences Following Transcatheter Atrial Fibrillation Ablation

Atrial fibrillation (AF) relapses, following transcatheter AF ablation, are frequently reported based on patients' symptoms, scheduled electrocardiograms (ECGs), or 24-hour Holter recordings. The aim of this study is to determine the incidence of asymptomatic and symptomatic AF recurrences, using continuous subcutaneous ECG monitoring, in the long-term follow-up of patients with paroxysmal or persistent AF undergoing transcatheter ablation. In total 113 consecutive patients symptomatic for paroxysmal or persistent AF were enrolled. All patients underwent pulmonary vein isolation plus left linear lesions. The insertable cardiac monitor (ICM), subcutaneously implanted during the ablation procedure, recorded the amount of AF per day (daily burden) and per last follow-up period (total AF burden). Based on symptoms and on scheduled 12-lead ECG performed during follow-up, 40 patients (35.4%) suffered AF recurrences. By means of ICM data, however, arrhythmia relapses were recorded within 75 patients (66.3%), of whom 35 (46.7%) were asymptomatic. Patients suffering symptomatic AF recurrences resulted, at univariate analysis, older (66.6 ± 8.4 years vs 61.6 ± 10.7 years) and suffering greater AF burden (88.8 ± 26.9% vs 8.0 ± 8.0%). AF ablation outcome based on patients' symptoms and/or scheduled ECGs underestimated relapses, as up to half of the patients, during a long-term follow-up, suffer asymptomatic recurrences.

Long-Term Clinical Results of 2 Different Ablation Strategies in Patients With Paroxysmal and Persistent Atrial Fibrillation

Data regarding the long-term efficacy of atrial fibrillation (AF) ablation are still lacking. Two hundred four consecutive patients symptomatic for paroxysmal or persistent/permanent AF were randomly assigned to 2 different ablation schemes: pulmonary vein isolation (PVI) and PVI plus left linear lesions (LL). Primary end point was to assess the maintenance of sinus rhythm (SR) after procedures 1 and 2 in the absence of antiarrhythmic drugs in a long-term follow-up of at least 3 years. Paroxysmal AF- With a single procedure at 12-month follow-up, 46% of patients treated with PVI maintained SR, whereas at 3-year follow-up, 29% were in SR; using the "PVI plus LL" at the 12-month follow-up, 57% of patients were in SR, whereas at the 3-year follow-up, 53% remained in SR. After a second procedure, the long-term overall success rate without antiarrhythmic drugs was 62% with PVI and 85% with PVI plus LL. Persistent/Permanent AF- With a single procedure at the 12-month follow-up, 27% of patients treated with PVI were in SR, whereas at the 3-year follow-up, 19% maintained SR; using the PVI plus LL with a single procedure at the 12-month follow-up 45% of patients were in SR, whereas at the 3-year follow-up, 41% remained in SR. After a second procedure, the long-term overall success rate without antiarrhythmic drugs was 39% with PVI and 75% with PVI plus LL. A long-term follow-up of AF ablation shows that short-term results cannot be considered permanent because AF recurrences are still present after the first year especially in patients who have had "PVI" strategy. PVI isolation plus LL is superior to the PVI strategy in maintaining SR without antiarrhythmic drugs after procedures 1 and 2 both in paroxysmal and persistent AF.