Key result
Linear ablation plus PVI linked to ~35% higher 8-year arrhythmia-free survival vs electrogram-guided ablation.
Why the study?
The optimal ablation strategy for persistent atrial fibrillation remains to be defined.
Does pulmonary vein isolation plus linear ablation improve long-term arrhythmia-free survival compared to pulmonary vein isolation plus electrogram-guided ablation in patients with persistent atrial fibrillation?
Cohort (n=104)
No
Does pulmonary vein isolation plus linear ablation improve long-term arrhythmia-free survival compared to pulmonary vein isolation plus electrogram-guided ablation in patients with persistent atrial fibrillation?
In patients with persistent atrial fibrillation, adding linear ablation to pulmonary vein isolation results in superior very long-term arrhythmia-free survival compared to adding electrogram-guided ablation.
May support linear ablation plus PVI in persistent AF; leaves open randomized confirmation before practice change.
The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n = 52) and one with PVI and EGM-guided ablation (EGM-group; n = 52). Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p = 0.76). During 100 ± 28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8 ± 0.9 procedures) compared with EGM-group (Logrank test: p = 0.0001 and p = 0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of atrial arrhythmia recurrence. Linear ablation might be a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.
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Yamashita et al. (2021) conducted a cohort in Persistent atrial fibrillation (n=104). Linear ablation (roof and mitral isthmus lines) plus pulmonary vein isolation vs. Electrogram-guided ablation plus pulmonary vein isolation was evaluated on Arrhythmia-free survival at 8 years after initial procedure (p=0.0001). Linear ablation combined with pulmonary vein isolation significantly improved 8-year arrhythmia-free survival compared to electrogram-guided ablation (54% vs 19%, p=0.0001) in persistent AF.
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