Does the amount of atrial mass reduction improve clinical outcomes after radiofrequency catheter ablation for long-standing persistent atrial fibrillation? Comparison between linear ablation and defragmentation

Seong Woo Han, Seung Yong Shin, Sung Il Im, Jin Oh Na, Cheol Ung Choi, Seong Hwan Kim, Jin Won Kim, Eung Ju Kim, Seung-Woon Rha, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Chun Hwang, Hong Euy Lim

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9 Citations (Scopus)

Abstract

Background Although a large isolated surface area of the left atrium (LA) may improve the success rate of catheter ablation (CA) for paroxysmal atrial fibrillation (AF), little is known about the relation between clinical outcomes and the amount of atrial mass reduction (AMR: ratio of total isolated and ablated areas to LA surface area) in different ablation strategies for patients with long-standing persistent AF (L-PeAF). Methods We randomly assigned 119 consecutive L-PeAF patients to adjunctive linear ablation (n = 60) or complex fractionated atrial electrogram (CFAE)-guided ablation (n = 59) after circumferential antral pulmonary vein isolation (PVI). Linear lesions included roof and anterior lines with conduction block. LA defragmentation was performed with an automated CFAE-detection algorithm. Cavotricuspid isthmus block was performed in all patients. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day post-CA. Results CK-MB and troponin-T levels were higher, ablation time was longer, and AMR was greater in the CFAE-guided ablation group than in the linear ablation group. AF termination during CA was more frequently observed in the linear ablation group than in the CFAE-guided ablation group (P = 0.031). Twelve months after a single procedure, recurrence occurred in 16 (26.7%) patients with linear ablation and 27 (45.8%) patients with CFAE-guided ablation (P = 0.023). On multivariate analysis, LA volume and ablation method were the only independent risk factors for arrhythmia recurrence. Conclusion Conduction block through linear lines + PVI was an efficient ablation strategy for L-PeAF, whereas the AMR amount did not influence clinical outcomes.

Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalInternational Journal of Cardiology
Volume171
Issue number1
DOIs
Publication statusPublished - 2014 Jan 15

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Cardiac Electrophysiologic Techniques
Catheter Ablation
Atrial Fibrillation
Heart Atria
MB Form Creatine Kinase
Troponin T
Pulmonary Veins
Recurrence
Cardiac Arrhythmias
Multivariate Analysis

Keywords

  • Atrial fibrillation
  • Atrial mass
  • Complex fractionated atrial electrograms
  • Linear ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{8a5eac74561047b886dc7d8626c45a71,
title = "Does the amount of atrial mass reduction improve clinical outcomes after radiofrequency catheter ablation for long-standing persistent atrial fibrillation? Comparison between linear ablation and defragmentation",
abstract = "Background Although a large isolated surface area of the left atrium (LA) may improve the success rate of catheter ablation (CA) for paroxysmal atrial fibrillation (AF), little is known about the relation between clinical outcomes and the amount of atrial mass reduction (AMR: ratio of total isolated and ablated areas to LA surface area) in different ablation strategies for patients with long-standing persistent AF (L-PeAF). Methods We randomly assigned 119 consecutive L-PeAF patients to adjunctive linear ablation (n = 60) or complex fractionated atrial electrogram (CFAE)-guided ablation (n = 59) after circumferential antral pulmonary vein isolation (PVI). Linear lesions included roof and anterior lines with conduction block. LA defragmentation was performed with an automated CFAE-detection algorithm. Cavotricuspid isthmus block was performed in all patients. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day post-CA. Results CK-MB and troponin-T levels were higher, ablation time was longer, and AMR was greater in the CFAE-guided ablation group than in the linear ablation group. AF termination during CA was more frequently observed in the linear ablation group than in the CFAE-guided ablation group (P = 0.031). Twelve months after a single procedure, recurrence occurred in 16 (26.7{\%}) patients with linear ablation and 27 (45.8{\%}) patients with CFAE-guided ablation (P = 0.023). On multivariate analysis, LA volume and ablation method were the only independent risk factors for arrhythmia recurrence. Conclusion Conduction block through linear lines + PVI was an efficient ablation strategy for L-PeAF, whereas the AMR amount did not influence clinical outcomes.",
keywords = "Atrial fibrillation, Atrial mass, Complex fractionated atrial electrograms, Linear ablation",
author = "Han, {Seong Woo} and Shin, {Seung Yong} and Im, {Sung Il} 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 = "2014",
month = "1",
day = "15",
doi = "10.1016/j.ijcard.2013.11.041",
language = "English",
volume = "171",
pages = "37--43",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
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TY - JOUR

T1 - Does the amount of atrial mass reduction improve clinical outcomes after radiofrequency catheter ablation for long-standing persistent atrial fibrillation? Comparison between linear ablation and defragmentation

AU - Han, Seong Woo

AU - Shin, Seung Yong

AU - Im, Sung Il

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 - 2014/1/15

Y1 - 2014/1/15

N2 - Background Although a large isolated surface area of the left atrium (LA) may improve the success rate of catheter ablation (CA) for paroxysmal atrial fibrillation (AF), little is known about the relation between clinical outcomes and the amount of atrial mass reduction (AMR: ratio of total isolated and ablated areas to LA surface area) in different ablation strategies for patients with long-standing persistent AF (L-PeAF). Methods We randomly assigned 119 consecutive L-PeAF patients to adjunctive linear ablation (n = 60) or complex fractionated atrial electrogram (CFAE)-guided ablation (n = 59) after circumferential antral pulmonary vein isolation (PVI). Linear lesions included roof and anterior lines with conduction block. LA defragmentation was performed with an automated CFAE-detection algorithm. Cavotricuspid isthmus block was performed in all patients. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day post-CA. Results CK-MB and troponin-T levels were higher, ablation time was longer, and AMR was greater in the CFAE-guided ablation group than in the linear ablation group. AF termination during CA was more frequently observed in the linear ablation group than in the CFAE-guided ablation group (P = 0.031). Twelve months after a single procedure, recurrence occurred in 16 (26.7%) patients with linear ablation and 27 (45.8%) patients with CFAE-guided ablation (P = 0.023). On multivariate analysis, LA volume and ablation method were the only independent risk factors for arrhythmia recurrence. Conclusion Conduction block through linear lines + PVI was an efficient ablation strategy for L-PeAF, whereas the AMR amount did not influence clinical outcomes.

AB - Background Although a large isolated surface area of the left atrium (LA) may improve the success rate of catheter ablation (CA) for paroxysmal atrial fibrillation (AF), little is known about the relation between clinical outcomes and the amount of atrial mass reduction (AMR: ratio of total isolated and ablated areas to LA surface area) in different ablation strategies for patients with long-standing persistent AF (L-PeAF). Methods We randomly assigned 119 consecutive L-PeAF patients to adjunctive linear ablation (n = 60) or complex fractionated atrial electrogram (CFAE)-guided ablation (n = 59) after circumferential antral pulmonary vein isolation (PVI). Linear lesions included roof and anterior lines with conduction block. LA defragmentation was performed with an automated CFAE-detection algorithm. Cavotricuspid isthmus block was performed in all patients. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1 day post-CA. Results CK-MB and troponin-T levels were higher, ablation time was longer, and AMR was greater in the CFAE-guided ablation group than in the linear ablation group. AF termination during CA was more frequently observed in the linear ablation group than in the CFAE-guided ablation group (P = 0.031). Twelve months after a single procedure, recurrence occurred in 16 (26.7%) patients with linear ablation and 27 (45.8%) patients with CFAE-guided ablation (P = 0.023). On multivariate analysis, LA volume and ablation method were the only independent risk factors for arrhythmia recurrence. Conclusion Conduction block through linear lines + PVI was an efficient ablation strategy for L-PeAF, whereas the AMR amount did not influence clinical outcomes.

KW - Atrial fibrillation

KW - Atrial mass

KW - Complex fractionated atrial electrograms

KW - Linear ablation

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DO - 10.1016/j.ijcard.2013.11.041

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