Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation
Abstract Background The value of additional ablation beyond pulmonary vein isolation for atrial fibrillation (AF) ablation is unclear, especially for persistent AF. It is uncertain whether substrate modification with additional extensive ablation improves outcomes. We reviewed our experience to dete...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-08-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.12727 |
| _version_ | 1818173049596280832 |
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| author | Joey Junarta Sean J. Dikdan Naman Upadhyay Andrea Molin Sairamya Bodempudi Eric Warner Daniel Joffe Zachary Pang Daniel R. Frisch |
| author_facet | Joey Junarta Sean J. Dikdan Naman Upadhyay Andrea Molin Sairamya Bodempudi Eric Warner Daniel Joffe Zachary Pang Daniel R. Frisch |
| author_sort | Joey Junarta |
| collection | DOAJ |
| description | Abstract Background The value of additional ablation beyond pulmonary vein isolation for atrial fibrillation (AF) ablation is unclear, especially for persistent AF. It is uncertain whether substrate modification with additional extensive ablation improves outcomes. We reviewed our experience to determine whether pulmonary vein isolation with additional extensive ablation (PVIEA) improves outcomes compared to pulmonary vein isolation alone (PVIA) for AF ablation. Methods Consecutive cases of patients with PVIA versus PVIEA were compared between September 9, 2013 and December 12, 2020. Procedural data collected include radiofrequency ablation delivery time (RADT) and arrhythmia inducibility. Clinical data collected include sinus rhythm maintenance post‐procedure. Results A total of 235 patients were studied (67 PVIA and 168 PVIEA). RADT was shorter when comparing ablation with PVIA versus PVIEA (32 vs. 40 min; p = .04). More arrhythmias were inducible with PVIEA (p < .01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log‐rank test p = .75), after 3 or 12 months between groups overall, and when stratified by AF type (paroxysmal and persistent), left atrial volume, CHA2DS2‐VASc score, left ventricular ejection fraction, or catheter ablation setting (high‐power short‐duration, standard‐power standard‐duration, temperature‐controlled non‐contact‐force). Conclusion AF ablation with PVIA or PVIEA produces similar sinus rhythm maintenance overall and when stratified by catheter setting and AF type. PVIA reduced procedure times and less arrhythmias were inducible post‐ablation. |
| first_indexed | 2024-12-11T19:22:20Z |
| format | Article |
| id | doaj.art-8398b456c1e048478cf55498726c2ab8 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-12-11T19:22:20Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-8398b456c1e048478cf55498726c2ab82022-12-22T00:53:30ZengWileyJournal of Arrhythmia1880-42761883-21482022-08-0138458959710.1002/joa3.12727Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillationJoey Junarta0Sean J. Dikdan1Naman Upadhyay2Andrea Molin3Sairamya Bodempudi4Eric Warner5Daniel Joffe6Zachary Pang7Daniel R. Frisch8Department of Medicine Thomas Jefferson University Hospital Philadelphia Pennsylvania USAJefferson Heart Institute Thomas Jefferson University Hospital Philadelphia Pennsylvania USADepartment of Medicine Thomas Jefferson University Hospital Philadelphia Pennsylvania USADepartment of Medicine Thomas Jefferson University Hospital Philadelphia Pennsylvania USADepartment of Medicine Thomas Jefferson University Hospital Philadelphia Pennsylvania USADepartment of Medicine Thomas Jefferson University Hospital Philadelphia Pennsylvania USASidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USASidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USAJefferson Heart Institute Thomas Jefferson University Hospital Philadelphia Pennsylvania USAAbstract Background The value of additional ablation beyond pulmonary vein isolation for atrial fibrillation (AF) ablation is unclear, especially for persistent AF. It is uncertain whether substrate modification with additional extensive ablation improves outcomes. We reviewed our experience to determine whether pulmonary vein isolation with additional extensive ablation (PVIEA) improves outcomes compared to pulmonary vein isolation alone (PVIA) for AF ablation. Methods Consecutive cases of patients with PVIA versus PVIEA were compared between September 9, 2013 and December 12, 2020. Procedural data collected include radiofrequency ablation delivery time (RADT) and arrhythmia inducibility. Clinical data collected include sinus rhythm maintenance post‐procedure. Results A total of 235 patients were studied (67 PVIA and 168 PVIEA). RADT was shorter when comparing ablation with PVIA versus PVIEA (32 vs. 40 min; p = .04). More arrhythmias were inducible with PVIEA (p < .01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log‐rank test p = .75), after 3 or 12 months between groups overall, and when stratified by AF type (paroxysmal and persistent), left atrial volume, CHA2DS2‐VASc score, left ventricular ejection fraction, or catheter ablation setting (high‐power short‐duration, standard‐power standard‐duration, temperature‐controlled non‐contact‐force). Conclusion AF ablation with PVIA or PVIEA produces similar sinus rhythm maintenance overall and when stratified by catheter setting and AF type. PVIA reduced procedure times and less arrhythmias were inducible post‐ablation.https://doi.org/10.1002/joa3.12727atrial fibrillationcatheter ablationelectrophysiologypersistent atrial fibrillationsubstrate modification |
| spellingShingle | Joey Junarta Sean J. Dikdan Naman Upadhyay Andrea Molin Sairamya Bodempudi Eric Warner Daniel Joffe Zachary Pang Daniel R. Frisch Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation Journal of Arrhythmia atrial fibrillation catheter ablation electrophysiology persistent atrial fibrillation substrate modification |
| title | Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation |
| title_full | Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation |
| title_fullStr | Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation |
| title_full_unstemmed | Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation |
| title_short | Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation |
| title_sort | pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation |
| topic | atrial fibrillation catheter ablation electrophysiology persistent atrial fibrillation substrate modification |
| url | https://doi.org/10.1002/joa3.12727 |
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