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One-year outcomes after pulmonary vein isolation plus posterior wall isolation and additional non-pulmonary vein trigger ablation for persistent atrial fibrillation with or without contact force sensing: a propensity score-matched comparison

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Abstract

Purpose

Whether or not pulmonary vein isolation (PVI) plus left atrial posterior wall isolation (PWI) using contact force (CF) sensing improves the ablation outcome for persistent atrial fibrillation (AF) is unclear. This study compared the outcome of PVI plus PWI and additional non-PV trigger ablation for persistent AF with/without CF sensing.

Methods

This retrospective cohort study analyzed 148 propensity score-matched persistent AF patients (median duration of persistent AF, 8 months (interquartile range, 3–24 months); left atrial diameter, 43 ± 7 mm) undergoing PVI plus PWI and ablation of non-PV triggers provoked by high-dose isoproterenol, including 74 with CF-sensing catheters (CF group) and 74 with conventional catheters (non-CF group). PVI plus PWI with no additional ablation but cavotricuspid isthmus ablation was performed without non-PV triggers in 48 CF patients (65%) and 54 non-CF patients (73%) (P = 0.38). In all other patients, we performed additional ablation of provoked non-PV triggers.

Results

The Kaplan-Meier estimate of the rate of freedom from atrial tachyarrhythmia recurrence off antiarrhythmic drugs at 12 months after the single procedure was higher in the CF group than in the non-CF group (85 vs. 70%, log-rank P = 0.030). A multivariable analysis revealed that using CF sensing and non-inducibility of AF from a non-PV trigger after PVI and PWI were significantly associated with a reduced rate of atrial tachyarrhythmia recurrence.

Conclusions

Compared with non-CF sensing, PVI plus PWI and additional non-PV trigger ablation using CF-sensing catheters for persistent AF can reduce the rate of atrial tachyarrhythmia recurrence.

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Acknowledgments

The authors are grateful to Dongki Hong (Biosense Webster Inc.) and Masashi Uemoto (Abbott Medical Japan Co.) for the CF analysis. We also thank Dr. Brian Quinn (Japan Medical Communication Inc.) for the English language editing.

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Authors and Affiliations

  1. Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintosin, Chuo-ku, Saitama-shi, Saitama, 330-8553, Japan

    Tomomasa Takamiya, Osamu Inaba, Akira Sato, Takashi Ikenouchi, Kazuya Murata & Yukihiro Inamura

  2. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan

    Junichi Nitta

  3. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyou-ku, Tokyo, 113-8510, Japan

    Yoshihide Takahashi, Masahiko Goya & Kenzo Hirao

Authors
  1. Tomomasa Takamiya
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  2. Junichi Nitta
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  3. Osamu Inaba
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  4. Akira Sato
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Corresponding author

Correspondence to Tomomasa Takamiya.

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Conflict of interest

Y.T. and M.G. received speaker honoraria or research grant from Biosense-Webster, Abbott, and Japan Life Line. K.H. holds a research funding from Japan Life Line and Abbott. The remaining authors have no disclosures.

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Takamiya, T., Nitta, J., Inaba, O. et al. One-year outcomes after pulmonary vein isolation plus posterior wall isolation and additional non-pulmonary vein trigger ablation for persistent atrial fibrillation with or without contact force sensing: a propensity score-matched comparison. J Interv Card Electrophysiol 59, 585–593 (2020). https://doi.org/10.1007/s10840-019-00700-1

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  • DOI: https://doi.org/10.1007/s10840-019-00700-1

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