Key result
Contact-force guided PWI plus PVI yields ~81% one-year arrhythmia-free survival in persistent AF.
Why the study?
The efficacy of posterior wall isolation on top of pulmonary vein isolation in persistent AF remains controversial, and the impact of contact-force technology is poorly understood.
Does posterior wall isolation using contact-force sensing catheters on top of pulmonary vein isolation reduce atrial arrhythmic recurrences in patients with persistent atrial fibrillation?
Cohort (n=73)
No
Does posterior wall isolation using contact-force sensing catheters on top of pulmonary vein isolation reduce atrial arrhythmic recurrences in patients with persistent atrial fibrillation?
Contact-force guided posterior wall isolation added to pulmonary vein isolation is safe and achieves 64.1% arrhythmia-free survival at 2 years in patients with persistent atrial fibrillation.
Supports adjunctive contact-force PWI in persistent AF; leaves open incremental benefit over PVI alone pending randomized trials.
BACKGROUND: The efficacy of posterior wall isolation (PWI) on top of pulmonary vein isolation (PVI) in patients affected by persistent atrial fibrillation (AF) is still controversial and little is known about the impact of contact-force (CF) technology. OBJECTIVE: In this retrospective study, we present our experience with PWI using CF sensing catheters and its efficacy and safety as an adjunctive ablation strategy on top of PVI for management of patients with persistent and longstanding persistent AF. METHODS: A total of 73 consecutive patients (20.5% female) affected by persistent atrial fibrillation (10.9% long-standing) underwent PWI as an adjunctive therapy to PVI using CF sensing catheters. Outcomes were reported as incidence of atrial arrhythmic recurrences (ARs) lasting >30 seconds at follow up and in addition, in patients provided with insertable cardiac monitors (ICM), as burden of AF or atrial tachycardias (AT) at relevant time points. RESULTS: PWI was successfully achieved in 65 (89.0%) patients. Two (2.7%) minor vascular procedural complications were observed. At 1 and 2-year follow-up, ARs free survival was observed in 80.5% and 64.1% of patients, respectively with 75.3% of patients off antiarrhythmic drugs at the last follow-up. Ten patients underwent repeat ablations during the follow-up. At multivariate analysis, early ARs within 3 months after procedure, were associated with a two-fold increased risk of late ARs at follow-up. Among patients provided with ICM, PWI on top of PVI was able to reduce the mean AT/AF burden of more than 50% compared with pre-ablation time, reporting very low levels (≤ 5%) over 2 years. CONCLUSIONS: In persistent atrial fibrillation, PWI on top of PVI using CF sensing catheters is safe and effective, providing great reduction of burden of ARs. Early ARs are associated with a greater risk of late recurrences.
No takes yet. Share an insight, caveat, or question.
G. Sirico (2021) conducted a cohort in Persistent atrial fibrillation (n=73). Contact-force guided posterior wall isolation (PWI) on top of pulmonary vein isolation (PVI) was evaluated on Freedom from atrial arrhythmic recurrences lasting >30 seconds at 1 year. Contact-force guided posterior wall isolation on top of pulmonary vein isolation achieved an arrhythmia-free survival of 80.5% at 1 year and 64.1% at 2 years in persistent atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: