Clinical outcome when left atrial posterior wall box isolation is included as a catheter ablation strategy in patients with persistent atrial fibrillation
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Isolation of the pulmonary veins alone (PVI) is associated with a 50 to 70 % success rate in paroxysmal atrial fibrillation (AF) but is significantly lower for persistent AF. We sought to evaluate patient outcomes in terms of safety and efficacy when posterior left atrial box isolation is included as a catheter ablation strategy in patients with mainly persistent AF.
We performed an audit of 100 patients undergoing left atrial (LA) box isolation. Recurrence of arrhythmia was detected by evaluating symptoms and continuous 24 h ECG monitoring at 2, 6 and 12 months post procedure.
Seventy-two patients had persistent AF prior to procedure. Average duration of AF was 5.4 ± 5.2 years. All patients underwent circumferential PVI plus linear posterior LA lines to complete box isolation. At a mean follow-up of 12.5 ± 4.2 months, 75 patients were free from atrial fibrillation, 50.6 % of these were taking no antiarrhythmic medication. Twenty-five patients had recurrence of AF, 84 % of whom had previous persistent AF. The average time to recurrence post procedure was 5.9 ± 4.4 months. Thirteen patients underwent repeat procedures for recurrent AF. There were no adverse events relating to the procedure.
These results suggest that the strategy of left atrial box isolation is safe and effective, worthy of further evaluation in a multicentre registry.
KeywordsAtrial fibrillation Persistent Box isolation Safety Efficacy
- 1.Calkins, H., Reynolds, M. R., Spector, P., Sondhi, M., Xu, Y., Martin, A., et al. (2009). Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circulation. Arrhythmia and Electrophysiology, 2(4), 349–361.CrossRefPubMedGoogle Scholar
- 6.Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm, 9(4), 632–696.CrossRefPubMedGoogle Scholar
- 8.Tamborero, D., Mont, L., Berruezo, A., Matiello, M., Benito, B., Sitges, M., et al. (2009). Left atrial posterior wall isolation does not improve the outcome of circumferential pulmonary vein ablation for atrial fibrillation: a prospective randomized study. Circulation. Arrhythmia and Electrophysiology, 2(1), 35–40.CrossRefPubMedGoogle Scholar
- 9.Mun, H. S., Joung, B., Shim, J., Hwang, H. J., Kim, J. Y., Lee, M. H., et al. (2012). Does additional linear ablation after circumferential pulmonary vein isolation improve clinical outcome in patients with paroxysmal atrial fibrillation? Prospective randomised study. Heart, 98(6), 480–484.CrossRefPubMedCentralPubMedGoogle Scholar
- 12.Todd, D. M., Skanes, A. C., Guiraudon, G., Guiraudon, C., Krahn, A. D., Yee, R., et al. (2003). Role of the posterior left atrium and pulmonary veins in human lone atrial fibrillation: electrophysiological and pathological data from patients undergoing atrial fibrillation surgery. Circulation, 108(25), 3108–3114.CrossRefPubMedGoogle Scholar
- 14.Verma, A., Jiang, C-Y., Betts, T., Chen, J., Deisenhofer, I., Mantovan, R., et al. (2015). Approaches to catheter ablation for persistent atrial fibrillation. New England Journal of Medicine, 372(19), 1812–1822.Google Scholar
- 15.Matsuo, S., Lellouche, N., Wright, M., Bevilacqua, M., Knecht, S., Nault, I., Lim, K. T., et al. (2009). Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation. Journal of the American College of Cardiology, 54(9), 788–795.CrossRefPubMedGoogle Scholar
- 17.Keane, D. (2012). Boston Atrial Fibrillation SymposiumGoogle Scholar
- 19.Muller, P., Dietrich, J. W., Halbfass, P., Abouarab, A., Fochler, F., Szöllösi, A., et al. (2015). Higher incidence of esophageal lesions after AF ablation related to the use of esophageal temperature probes. Heart Rhythm Google Scholar
- 20.Verma, A., Champagne, J., Sapp, J., Essebag, V., Novak, P., & Skanes, A. (2013). Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study. JAMA Internal Medicine, 173(2), 149–156.CrossRefPubMedGoogle Scholar
- 21.Kapa, S., Epstein, A. E., Callans, D. J., Garcia, F. C., Lin, D., & Bala, R. (2013). Assessing arrhythmia burden after catheter ablation of atrial fibrillation using an implantable loop recorder: the ABACUS study. Journal of Cardiovascular Electrophysiology, 24(8), 875–881.CrossRefPubMedGoogle Scholar