Efficacy of atrial substrate modification based on dominant frequency of paroxysmal atrial fibrillation

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• 作者：Koji Kumagai ; PhD ; ^{kkumagai4917@yahoo.co.jp" class="auth_mail" title="E-mail the corresponding author} (MD) ; Kentaro Minami ^{leeluu1103@gmail.com" class="auth_mail" title="E-mail the corresponding author} (MD) ; Daisuke Kutsuzawa ; PhD ^{truth.1105@gmail.com" class="auth_mail" title="E-mail the corresponding author} (MD) ; Shigeru Oshima ; PhD ^{ohsima.s@cvc.pref.gunma.jp" class="auth_mail" title="E-mail the corresponding author} (MD)
• 关键词：Ablation ; Atrial arrhythmias ; Dominant frequency ; Inducibility ; Pulmonary vein isolation
• 刊名：Journal of Arrhythmia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：32
• 期：3
• 页码：212-217
• 全文大小：1353 K

文摘

The endpoint of ablation procedures is suggested to be non-inducibility of paroxysmal atrial fibrillation (PAF). However, the prognosis of induced AF/atrial tachycardia (AT) after pulmonary vein isolation (PVI) in PAF patients remains unclear.

Methods

A total of 122 PAF patients were divided into the following 3 groups: Group 1, 79 without AF/AT induced after PVI; Group 2, 21 with AF/AT induced or sustained after PVI, and followed by a high-dominant frequency (DF) and continuous complex fractionated atrial electrogram (CFAE) site ablation and, if necessary, linear ablation; and Group 3, 22 with external cardioversion of AF/AT induced or sustained after PVI. High-DF (DF≥8 Hz) and continuous CFAE (fractionated intervals≤50 ms) sites were targeted. The ablation endpoint was non-inducibility of PAF.

Results

In Group 2, AF terminated in 2 patients with a high-DF and continuous CFAE site ablation. In 4 patients, AF induced after cardioversion did not terminate with left atrium linear ablation, and required additional cardioversion. Common atrial flutter in 2 patients terminated with cavotricuspid isthmus ablation. An AT terminated with a roofline ablation. Finally, no AF/AT could be induced in any of the patients in Group 2 after all the procedures. The cumulative freedom from AF/AT recurrence without antiarrhythmic drugs in Groups 1 and 2 was significantly greater than that in Group 3 after 1 procedure during 12 months of follow-up (90% and 91% vs. 64%, Log-rank test P=0.001 and P=0.033, respectively).

Conclusions

Atrial substrate ablation may improve the clinical outcome after ablation in patients after PVI with residual arrhythmia inducibility.