Impact of atrial fibrillation termination mode during catheter ablation procedure on maintenance of sinus rhythm

Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: A prospective study

“…8 In the second study using PV isolation and complex fractionated electrogram ablation, the low SR restoration rate (14%) offered limited statistical power to detect the association with outcome. 9 Our observation is in accordance with the results of studies in patients having all forms of persistent AF 2,4,6,18,[12][13][14][15][16][17][18][19][20][21][22] and confirms that the predictive value of restored SR at initial ablation extends beyond repeat procedures. 4,5,22 In patients with persistent AF, prior investigations of preprocedural factors identified smaller LA size, 2,22 shorter continuous AF duration, 1,2,4,8,21 younger age, 5,23 male gender, 4 absence of congestive heart failure, 4 absence of hypertension, 5 higher LAA outflow velocity, 15 LA systolic strain, and LAA wall velocity 22 as the predictors of arrhythmia-free outcome after the initial or repeat procedure(s).…”

“…In prior studies of mixed persistent AF populations or small series of selected patients with LSPAF, this end-point was predicted by shorter duration of continuous AF, 1 smaller LA size, 5 better LAA mechanical function, 16,17 or preserved LV ejection fraction. 18 We confirmed lower SR restoration rate in patients with shorter LAA AFCL, which had been earlier explained by an inverse relationship between AFCL and the number of distinct AF sources. 1,3,5,18,19 Surprisingly, we further found that the long-axis LA diameter outweighed other parameters of LA size, including LA volume.…”

“…18 We confirmed lower SR restoration rate in patients with shorter LAA AFCL, which had been earlier explained by an inverse relationship between AFCL and the number of distinct AF sources. 1,3,5,18,19 Surprisingly, we further found that the long-axis LA diameter outweighed other parameters of LA size, including LA volume. We can speculate that such "tall" LA shapes may be susceptible to ablation failure because of the greater mass of potentially arrhythmogenic atrial myocardium between the isolated venous compartment and the mitral annulus.…”

Correlates of Arrhythmia Recurrence After Hybrid Epi- and Endocardial Radiofrequency Ablation for Persistent Atrial Fibrillation

“…Our conclusion is in agreement with other published data derived from catheter-based procedures dealing with structurally remodeled atria. 20,23,29,30 However, in contrast to CA techniques, the staged hybrid approach allows testing of arrhythmia inducibility during the first CA procedure and allows to meaningfully target all clinically relevant atrial arrhythmias, something which is considered largely unrealistic because of time constraints and technical demands associated with a catheter-only approach. As a result, >90% of patients had been rendered noninducible by the end of our hybrid procedure.…”

Occurrence of Focal Atrial Tachycardia During the Ablation Procedure Is Associated With Arrhythmia Recurrence After Termination of Persistent Atrial Fibrillation

“…Stepwise ablation strategy has been developed for persistent AF, in which electrogram‐based ablation and linear ablation are performed in addition to PV isolation, with the procedural endpoint of termination of AF by ablation . During stepwise ablation, atrial tachycardias (ATs) commonly occur immediately after termination of AF, requiring ablation . Stepwise ablation strategy is recognized as an aggressive strategy, and recurrence of AF is unusual following this strategy if AF was terminated by ablation.…”