Circumferential Ablation With Pulmonary Vein Isolation in Permanent Atrial Fibrillation

Cheema, Aamir; Dong, Jun; Dalal, Darshan; Marine, Joseph E.; Henrikson, Charles A.; Spragg, David D.; Cheng, Alan; Nazarian, Saman; Bilchick, Kenneth C.; Almasry, Ibrahim; Sinha, Sunil K.; Scherr, Douglas S.; Halperin, Henry R.; Berger, Ronald D.; Calkins, Hugh

doi:10.1016/j.amjcard.2006.12.073

Cited by 57 publications

(49 citation statements)

References 13 publications

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“…In the four studies that performed antral encirclement, the majority confirmed PV disconnection 4,7,14 . These studies reported superior, but variant (37-56%) single procedure success rates compared to PVI alone (Table 1 and Figure 3).…”

Section: Pva Ablation With and Without Isolationmentioning

confidence: 99%

“…These studies reported superior, but variant (37-56%) single procedure success rates compared to PVI alone (Table 1 and Figure 3). The large variation in success could be due to fact that Pappone and colleagues 15 defined long-standing persistent AF as that >3 months compared to Cheema et al 14 , who enrolled patients with >6 months of continuous AF. The mean LA dimension of 58±11 mm in the latter study was also consistent with a more severely diseased cohort, and hence, the lowest clinical success.…”

Section: Pva Ablation With and Without Isolationmentioning

confidence: 99%

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Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

et al. 2010

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Section: Pva Ablation With and Without Isolationmentioning

confidence: 99%

Section: Pva Ablation With and Without Isolationmentioning

confidence: 99%

Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

et al. 2010

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“…16 All ablation procedures were performed while patients were in sinus rhythm. Patients either presented in sinus rhythm or were cardioverted to sinus rhythm before the start of the ablation procedure.…”

Section: Ablation Procedures and Lapmentioning

confidence: 99%

Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

Khurram

Maqbool

Berger

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Atrial fibrillation (AF) is associated with significant abnormalities of left atrial (LA) systolic and diastolic function. This study describes a novel measure, LA stiffness index, that estimates LA diastolic function and its association with clinical outcomes of catheter ablation. Methods and Results-A total of 219 AF patients referred for ablation (59% paroxysmal, mean CHA 2 DS 2 VASc score 1.7±1.4) were enrolled. Atrial pressure and volume loops were prepared from invasive pressure measures and cardiac magnetic resonance imaging volumetric data during sinus rhythm for all patients. An LA stiffness index was created, defined by the ratio of change in LA pressure to volume during passive filling of LA (ΔP/ΔV). Patients were followed prospectively. Mean LA stiffness index for AF patients was 0.6±0.5 mm Hg/mL (paroxysmal AF 0.51±0.4 and persistent AF 0.73±0.6; P<0.001). Linear regression analysis showed a rise in the stiffness index with age, increasing at a rate of 0.02 mm Hg/mL per year (P<0.001). The LA stiffness index was higher in patients with previous LA ablation(s) for AF (0.51±0.35 versus 0.83±0.70; P<0.001). Forty of 160 patients had recurrence after AF ablation with a mean follow-up of 10.4±7.6 months. Patients with recurrence had higher stiffness index than those without recurrence (0.83±0.46 versus 0.40±0.22; P<0.001). Conclusions-LA stiffness index, a novel measure to assess LA diastolic function, increases with age and is higher in persistent AF and in the setting of repeat AF ablation. Greater LA stiffness index was independently associated with recurrence of AF after LA ablation. (Circ Arrhythm Electrophysiol. 2016;9:e003163.

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“…[1][2][3] This strategy, although effective in maintaining sinus rhythm (SR) for PAF, 3 has limited success in persistent AF (PsAF). 1,[4][5][6][7] The understanding of the substrate maintaining persistent AF remains rudimentary. The targets and end points of PsAF ablation are ill-defined, and there is no consensus on the optimal ablation strategy in these patients.…”

mentioning

confidence: 99%

Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint

Scherr

Khairy

Miyazaki

et al. 2015

Circ: Arrhythmia and Electrophysiology

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254

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Background-This study aimed to determine 5-year efficacy of catheter ablation for persistent atrial fibrillation (AF) using AF termination as a procedural end point. Methods and Results-One hundred fifty patients (57±10 years) underwent persistent AF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided, and linear ablation) with the desired procedural end point being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia. AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3%±3.9%, 28.0%±3.7%, and 16.8%±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7%±2.5%, 79.8%±3.4%, and 62.9%±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (interquartile range, 43-73) months after the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs. Another 14 (9.3%) patients maintained sinus rhythm after reinitiation of antiarrhythmic drugs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (hazard ratio 3.831; 95% confidence interval, 2.070-7.143; P<0.001), left atrial diameter ≥50 mm (hazard ratio 2.083; 95% confidence interval, 1.078-4.016; P=0.03), continuous AF duration ≥18 months (hazard ratio 1.984; 95% confidence interval, 1.024-3.846; P<0.04), and structural heart disease (hazard ratio 1.874; 95% confidence interval, 1.037-3.388; P=0.04) predicted arrhythmia recurrence. Conclusions-In patients with persistent AF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow-up period. Procedural AF nontermination and specific baseline factors predict long-term outcome after ablation. (Circ Arrhythm Electrophysiol. 2015;8:18-24.

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Circumferential Ablation With Pulmonary Vein Isolation in Permanent Atrial Fibrillation

Cited by 57 publications

References 13 publications

Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint

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