Single ring isolation is superior to circumferential pulmonary vein isolation plus modified posterior box isolation with a high power of 40-45 W in patients with persistent atrial fibrillation

Abstract

This study aimed to evaluate the superiority of single ring isolation (SRI) over circumferential pulmonary vein isolation (CPVI) plus modified posterior box isolation (MPOBI) using a high power of 40-45 W in patients with persistent atrial fibrillation (PeAF). We retrospectively studied 77 PeAF patients who underwent primary radiofrequency catheter ablation (RFCA). They were divided into the SRI group and the CPVI+MPOBI group according to the RFCA methods. Basic characteristics, procedural variables and AF recurrence rates at 3 months postprocedure were collected and compared between the two groups after propensity score matching (PSM) for age and left atrial diameter. After PSM, 28 patients in the SRI group were matched with 28 individuals in the CPVI+MPOBI group. Compared with the CPVI+MPOBI group, the total procedure time in the SRI group was not significantly shorter ( P =0.928). The total ablation time and ablation time of the PVs and posterior left atrium (ring ablation time) of patients with SRI were significantly shorter than those of patients with CPVI+MPOBI (all P <0.001). The total ablation spots and initial ring spots in the SRI group were significantly fewer than those in the CPVI+MPOBI group (all P <0.001), but the total additional spots were not different between the two groups (P=0.060). The proportion of immediate sinus rhythm was significantly higher in patients with SRI than in those with CPVI+MPOBI (P<0.001). At the follow-up analysis, the AF recurrence rate did not significantly differ between the SRI and CPVI+ MPOBI groups (14.3% vs. 17.9%, P=0.716). In conclusion, this study demonstrated that SRI with a high power was safe and effective for patients with PeAF, and it was superior to CPVI+MPOBI.