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July 27, 2022Open Access

Efficacy and safety linear ablation for persistent atrial fibrillation: PVI plus linear ablation of mitral isthmus and posterior box isolation

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Why the study?

Whether linear ablation should be performed for persistent AF remains controversial, and the efficacy and safety of AI-guided high-energy linear ablation of the mitral isthmus and LA posterior wall are unclear.

Does PVI combined with AI-guided high-power linear ablation of the mitral isthmus and left atrial posterior wall prevent arrhythmia recurrence in patients with persistent atrial fibrillation?

Population

200 consecutive PAF patients

Comparison

PVI combined with AI-guided high-power linear ablation of LAPWI and MI

Design

Single-arm prospective study

Follow-up

Average 24 months

Key result

Pulmonary vein isolation combined with ablation index-guided high-power linear ablation of the mitral isthmus and posterior box isolation achieved an 87.5% freedom from atrial arrhythmia in patients with persistent atrial fibrillation.

Authors

XLXi LiTLTao LiuBCBo Cui

Discussion

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Member takes

Overview

May support this ablation strategy in persistent AF; hypothesis-generating and requires randomized confirmation.

Study Design

Type

Observational (n=200)

Multicenter

No

Structured PICO

Does PVI combined with AI-guided high-power linear ablation of the mitral isthmus and left atrial posterior wall prevent arrhythmia recurrence in patients with persistent atrial fibrillation?

P
Population
200 consecutive patients with persistent atrial fibrillation (PAF) lasting ≥7 days, mean age 58±10 years, 73% male, based in China. Exclusion criteria: valvular AF, history of cardiac surgery, dialysis or heart failure (LVEF < 30% and NYHA class III or IV), left atrial thrombus, and age ≥80 years.
I
Intervention
Pulmonary vein isolation (PVI) combined with ablation index (AI)-guided high-power linear ablation of the left atrial (LA) roof, posterior inferior (LA posterior wall isolation), and mitral isthmus (MI). Ablation was performed in power-control mode at 45W for 10-30 seconds, targeting AI 400-500.
O
Outcome
Freedom from atrial fibrillation (AF) or atrial tachycardia (AT) recurrence (defined as any episode lasting >30 seconds after a 3-month blanking period) at an average follow-up of 20±7 months.composite

PVI combined with AI-guided high-power linear ablation of the mitral isthmus and posterior box is a feasible and effective strategy for persistent atrial fibrillation, achieving an 87.5% freedom from arrhythmia at 20 months.

Limitations

  • Single-center study design
  • Retrospective nature requiring prospective confirmation
  • Single-center endeavor
  • Retrospective study that needs prospective confirmation

Cite This Study

Li et al. (2022) conducted an observational in Persistent atrial fibrillation (n=200). Pulmonary vein isolation (PVI) plus AI-guided high-power linear ablation of mitral isthmus and posterior box isolation was evaluated on Freedom from atrial fibrillation or atrial tachycardia. Pulmonary vein isolation combined with ablation index-guided high-power linear ablation of the mitral isthmus and posterior box isolation achieved an 87.5% freedom from atrial arrhythmia in patients with persistent atrial fibrillation.

synapsesocial.com/papers/6a0eddd11c5e2d2319f9feddhttps://doi.org/10.21203/rs.3.rs-1854055/v1
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