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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation
Heart Rhythm, Volume 7, No. 9, Year 2010
Notification
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Description
Background: Ablation of long-standing persistent atrial fibrillation (AF) remains challenging, with a lower success rate than paroxysmal AF. A reliable ablation endpoint has not been demonstrated yet, although AF termination during ablation may be associated with higher long-term maintenance of sinus rhythm (SR). Objective: The purpose of this study was to determine whether the method of AF termination during ablation predicts mode of recurrence or long-term outcome. Methods: Three hundred six patients with long-standing persistent AF, free of antiarrhythmic drugs (AADs), undergoing a first radiofrequency ablation (pulmonary vein [PV] antrum isolation and complex fractionated atrial electrograms) were prospectively included. Organized atrial tachyarrhythmias (AT) that occurred during AF ablation were targeted. AF termination mode during ablation was studied in relation to other variables (characteristics of arrhythmia recurrence, redo procedures, the use of adenosine/isoproterenol for redo, and comparison of focal versus macroreentrant ATs). Long-term maintenance of SR was assessed during the follow-up. Results: During AF ablation, six of 306 patients converted directly to SR, 172 patients organized into AT (with 38 of them converting in SR with further ablation), and 128 did not organize or terminate and were cardioverted. Two hundred eleven of 306 patients (69%) maintained in long-term SR without AADs after a mean follow-up of 25 ± 6.9 months, with no statistical difference between the various AF termination modes during ablation. Presence or absence of organization during ablation clearly predicted the predominant mode of recurrence, respectively, AT or AF (P = .022). Among the 74 redo ablation patients, 24 patients (32%) had extra PV triggers revealed by adenosine/isoproterenol. Termination of focal ATs was correlated with higher long-term success rate (24/29, 83%) than termination of macroreentrant ATs (20/35, 57%; P = .026). Conclusion: AF termination during ablation (conversion to AT or SR) could predict the mode of arrhythmia recurrence (AT vs. AF) but did not impact the long-term SR maintenance after one or two procedures. AT termination with further ablation did not correlate with better long-term outcome, except with focal ATs, for which termination seems critical. © 2010 Heart Rhythm Society.
Authors & Co-Authors
Elayi, Claude Samy
United States, Lexington
Lexington
Di Biase, Luigi
United States, Austin
Texas Cardiac Arrhythmia Institute
Italy, Foggia
Università Degli Studi Di Foggia
United States, Austin
The University of Texas at Austin
Barrett, Conor
United States, Boston
Massachusetts General Hospital
Ching, Chi Keong
Singapore, Singapore City
National Heart Centre Singapore
Aly, Moataz Al
Egypt, Giza
Cairo University
Lucciola, Maria
Italy, Turin
Università Degli Studi Di Torino
Bai, Rong
China, Wuhan
Huazhong University of Science and Technology
Horton, Rodney P.
United States, Austin
Texas Cardiac Arrhythmia Institute
Fahmy, Tamer S.
Egypt, Giza
Cairo University
Verma, Atul
Canada, Newmarket
Southlake Regional Health Centre
Khaykin, Yaariv
Canada, Newmarket
Southlake Regional Health Centre
Shah, Jignesh
United States, Lexington
Lexington
Morales, Gustavo X.
United States, Lexington
Lexington
Hongo, Richard
United States, San Francisco
California Pacific Medical Center
Hao, Steven
United States, San Francisco
California Pacific Medical Center
Beheiry, Salwa
United States, San Francisco
California Pacific Medical Center
Arruda, Mauricio
United States, Cleveland
Case Western Reserve University
Schweikert, Robert A.
United States, Akron
Akron General Hospital
Cummings, Jennifer
United States, Akron
Akron General Hospital
Burkhardt, J. David
United States, Austin
Texas Cardiac Arrhythmia Institute
Wang, Paul
United States, Palo Alto
Stanford University
Al-Ahmad, Amin
United States, Palo Alto
Stanford University
Cauchemez, Bruno
France, Neuilly
Clinique Ambroise Paré
Gaita, Fiorenzo
Italy, Turin
Università Degli Studi Di Torino
Natale, Andrea
United States, Austin
Texas Cardiac Arrhythmia Institute
United States, Austin
The University of Texas at Austin
United States, San Francisco
California Pacific Medical Center
United States, Palo Alto
Stanford University
Statistics
Citations: 25
Authors: 25
Affiliations: 15
Identifiers
Doi:
10.1016/j.hrthm.2010.01.038
ISSN:
15475271
Study Design
Cohort Study