‘Electrical exclusion’ of a critical myocardial mass by extended pulmonary vein antrum isolation for persistent atrial fibrillation treatment

UNLABELLED: The aim of the study was to compare the efficacy of pulmonary vein antrum isolation (PVAI), extended PVAI and ganglionic plexi (GP) ablation in persistent AF. METHODS: One hundred and twenty patients 56.2 ± 8.8 years old were randomized into three groups: GP ablation (n = 37), PVAI (n = 42), and extended PVAI (n = 41). The following parameters were studied: sinus rhythm restoration, vagal reactions, fluoroscopy time, procedure duration, lesion surface area. In 16 months after the procedure, echocardiography and Holter monitoring were performed. RESULTS: Significant differences were found in the amount of X-ray exposure, procedure duration, lesion surface area and vagal reactions. In all the cases, atrial mechanical function worsened after the procedure. However, there were no significant differences between the groups. Sixteen months after the procedure, sinus rhythm without antiarrhythmic therapy was maintained in 38% of patients in GP group, in 56% of patients in PVAI group and in 69% of patients in extended PVAI group. CONCLUSIONS: In persistent AF, the extended PVAI is more effective than PVAI and GP ablation. After the PVAI or extended PVAI, abnormalities of the left atrial mechanical function occurred if the lesion area exceeded 25% of the total LA surface area.