Why the study?
Whether radiofrequency ablation in fragmented late-gadolinium enhancement areas terminates persistent AF, converts it to AT, and improves rhythm outcomes was not well elucidated.
Does radiofrequency ablation targeting fragmented late-gadolinium enhancement areas reduce AF recurrence compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation?
Does radiofrequency ablation targeting fragmented late-gadolinium enhancement areas reduce AF recurrence compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation?
Targeting fragmented late-gadolinium enhancement areas during catheter ablation significantly reduces 12-month AF recurrence compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation.
FLA ablation was associated with lower AF recurrence in persistent AF; hypothesis-generating, requiring randomized confirmation before practice change.
BACKGROUND: A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome. METHODS: A total of 31 consecutive persistent AF patients with FLAs were enrolled (FLA ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). A favorable response was defined as direct AF termination or AT conversion during RF applications at the FLA. The rhythm outcome was compared between the FLA ablation group and FLA burden-matched pulmonary vein isolation (PVI) group. RESULTS: Favorable responses were found in 15 (48%) of 31 patients in the FLA group (AF termination in seven, AT conversion in eight patients), but not in the PVI group. AF recurrence at 12 months follow-up was significantly less in the FLA ablation group than in the PVI group (4 [13%] vs. 12 [39%] of 31 patients, log-rank p = .023). In patients with a favorable response, AT recurred in 1 (7%) of 15 patients, but AF did not. CONCLUSIONS: FLA ablation could terminate AF or convert it to AT in half of the patients. No AF recurrence was documented in patients with a favorable response.
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Kiuchi et al. (2021) studied this question.
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