Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation? A prospective randomized clinical trial

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Abstract

Introduction Although posterior wall of left atrium (LA) is known to be arrhythmogenic focus, little is known about the effect of posterior wall isolation (PWI) in patients who undergo radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (PeAF). Methods We randomly assigned 120 consecutive PeAF patients to additional PWI [PWI (+), n = 60] or control [PWI (-), n = 60] groups. In all patients, linear ablation was performed after circumferential pulmonary vein isolation (PVI). Linear lesions included roof, anterior perimitral, and cavotricuspid isthmus lines with conduction block. In PWI (+) group, posterior inferior linear lesion was also conducted. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day after RFCA. LA emptying fraction (LAEF) was assessed before and 12 months after RFCA. Results A total of 120 subjects were followed for 12 months after RFCA. There were no significant differences between two groups in baseline demographics and LA volume (LAV). The levels of CK-MB and troponin-T and procedure time were not significantly different between the groups. AF termination during RFCA was more frequently observed in PWI (+) than control (P = 0.035). During follow-up period, recurrence occurred in 10 (16.7%) patients in PWI (+) and 22 (36.7%) in control (P = 0.02). The change in LAEF was not significantly different between the groups. On multivariate analysis, smaller LAV and additional PWI were independently associated with procedure outcome. Conclusions PWI in addition to PVI plus linear lesions was an efficient strategy without deterioration of LA pump function in patients who underwent RFCA for PeAF.

Original languageEnglish
Pages (from-to)277-283
Number of pages7
JournalInternational Journal of Cardiology
Volume181
DOIs
Publication statusPublished - 2015 Feb 15

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Catheter Ablation
Atrial Fibrillation
Randomized Controlled Trials
Heart Atria
MB Form Creatine Kinase
Troponin T
Pulmonary Veins
Patient Isolation
Multivariate Analysis
Demography
Recurrence

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Left atrium
  • Posterior wall

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{8c614e4ae2944cf3a2b748685a269b3e,
title = "Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation?: A prospective randomized clinical trial",
abstract = "Introduction Although posterior wall of left atrium (LA) is known to be arrhythmogenic focus, little is known about the effect of posterior wall isolation (PWI) in patients who undergo radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (PeAF). Methods We randomly assigned 120 consecutive PeAF patients to additional PWI [PWI (+), n = 60] or control [PWI (-), n = 60] groups. In all patients, linear ablation was performed after circumferential pulmonary vein isolation (PVI). Linear lesions included roof, anterior perimitral, and cavotricuspid isthmus lines with conduction block. In PWI (+) group, posterior inferior linear lesion was also conducted. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day after RFCA. LA emptying fraction (LAEF) was assessed before and 12 months after RFCA. Results A total of 120 subjects were followed for 12 months after RFCA. There were no significant differences between two groups in baseline demographics and LA volume (LAV). The levels of CK-MB and troponin-T and procedure time were not significantly different between the groups. AF termination during RFCA was more frequently observed in PWI (+) than control (P = 0.035). During follow-up period, recurrence occurred in 10 (16.7{\%}) patients in PWI (+) and 22 (36.7{\%}) in control (P = 0.02). The change in LAEF was not significantly different between the groups. On multivariate analysis, smaller LAV and additional PWI were independently associated with procedure outcome. Conclusions PWI in addition to PVI plus linear lesions was an efficient strategy without deterioration of LA pump function in patients who underwent RFCA for PeAF.",
keywords = "Atrial fibrillation, Catheter ablation, Left atrium, Posterior wall",
author = "Jin-Seok Kim and Shin, {Seung Yong} and Na, {Jin Oh} and Choi, {Cheol Ung} and Kim, {Seong Hwan} and Kim, {Jin Won} and Kim, {Eung Ju} and Seung-Woon Rha and Park, {Chang Gyu} and Seo, {Hong Seog} and Oh, {Dong Joo} and Chun Hwang and Lim, {Hong Euy}",
year = "2015",
month = "2",
day = "15",
doi = "10.1016/j.ijcard.2014.12.035",
language = "English",
volume = "181",
pages = "277--283",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation?

T2 - A prospective randomized clinical trial

AU - Kim, Jin-Seok

AU - Shin, Seung Yong

AU - Na, Jin Oh

AU - Choi, Cheol Ung

AU - Kim, Seong Hwan

AU - Kim, Jin Won

AU - Kim, Eung Ju

AU - Rha, Seung-Woon

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

AU - Hwang, Chun

AU - Lim, Hong Euy

PY - 2015/2/15

Y1 - 2015/2/15

N2 - Introduction Although posterior wall of left atrium (LA) is known to be arrhythmogenic focus, little is known about the effect of posterior wall isolation (PWI) in patients who undergo radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (PeAF). Methods We randomly assigned 120 consecutive PeAF patients to additional PWI [PWI (+), n = 60] or control [PWI (-), n = 60] groups. In all patients, linear ablation was performed after circumferential pulmonary vein isolation (PVI). Linear lesions included roof, anterior perimitral, and cavotricuspid isthmus lines with conduction block. In PWI (+) group, posterior inferior linear lesion was also conducted. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day after RFCA. LA emptying fraction (LAEF) was assessed before and 12 months after RFCA. Results A total of 120 subjects were followed for 12 months after RFCA. There were no significant differences between two groups in baseline demographics and LA volume (LAV). The levels of CK-MB and troponin-T and procedure time were not significantly different between the groups. AF termination during RFCA was more frequently observed in PWI (+) than control (P = 0.035). During follow-up period, recurrence occurred in 10 (16.7%) patients in PWI (+) and 22 (36.7%) in control (P = 0.02). The change in LAEF was not significantly different between the groups. On multivariate analysis, smaller LAV and additional PWI were independently associated with procedure outcome. Conclusions PWI in addition to PVI plus linear lesions was an efficient strategy without deterioration of LA pump function in patients who underwent RFCA for PeAF.

AB - Introduction Although posterior wall of left atrium (LA) is known to be arrhythmogenic focus, little is known about the effect of posterior wall isolation (PWI) in patients who undergo radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (PeAF). Methods We randomly assigned 120 consecutive PeAF patients to additional PWI [PWI (+), n = 60] or control [PWI (-), n = 60] groups. In all patients, linear ablation was performed after circumferential pulmonary vein isolation (PVI). Linear lesions included roof, anterior perimitral, and cavotricuspid isthmus lines with conduction block. In PWI (+) group, posterior inferior linear lesion was also conducted. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day after RFCA. LA emptying fraction (LAEF) was assessed before and 12 months after RFCA. Results A total of 120 subjects were followed for 12 months after RFCA. There were no significant differences between two groups in baseline demographics and LA volume (LAV). The levels of CK-MB and troponin-T and procedure time were not significantly different between the groups. AF termination during RFCA was more frequently observed in PWI (+) than control (P = 0.035). During follow-up period, recurrence occurred in 10 (16.7%) patients in PWI (+) and 22 (36.7%) in control (P = 0.02). The change in LAEF was not significantly different between the groups. On multivariate analysis, smaller LAV and additional PWI were independently associated with procedure outcome. Conclusions PWI in addition to PVI plus linear lesions was an efficient strategy without deterioration of LA pump function in patients who underwent RFCA for PeAF.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Left atrium

KW - Posterior wall

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U2 - 10.1016/j.ijcard.2014.12.035

DO - 10.1016/j.ijcard.2014.12.035

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JO - International Journal of Cardiology

JF - International Journal of Cardiology

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