PVAI plus ablation of non-PV triggers was associated with a higher success rate (61%) compared to PVAI alone (18%) or PVAI plus scar homogenization (21%) (P<0.01).
Cohort (n=177)
Does PVAI combined with ablation of non-PV triggers or scar homogenization improve long-term AF-free survival compared to PVAI alone in patients with paroxysmal atrial fibrillation and severe left atrial scarring?
In patients with paroxysmal AF and severe LA scarring, adding non-PV trigger ablation to PVAI significantly improves long-term AF-free survival compared to PVAI alone or PVAI with scar homogenization.
Absolute Event Rate: 61% vs 18%
p-value: p=<0.01
AIMS: Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers. METHODS AND RESULTS: Totally, 177 consecutive patients with PAF and severe LA scarring were included. Patients underwent PVAI only (n = 45, Group 1), PVAI+ scar homogenization (n = 66, Group 2) or PVAI+ ablation of non-PV triggers (n = 66, Group 3) based on operator's choice. Baseline characteristics were similar across the groups. After first procedure, all patients were followed-up for a minimum of 2 years. The success rate at the end of the follow-up was 18% (8 pts), 21% (14 pts), and 61% (40 pts) in Groups 1, 2, and 3, respectively. Cumulative probability of AF-free survival was significantly higher in Group 3 (overall log-rank P <0.01, pairwise comparison 1 vs. 3 and 2 vs. 3 P < 0.01). During repeat procedures, non-PV triggers were ablated in all. After average 1.5 procedures, the success rates were 28 (62%), 41 (62%), and 56 (85%) in Groups 1, 2, and 3, respectively (log-rank P< 0.001). CONCLUSIONS: In patients with PAF and severe LA scarring, PVAI+ ablation of non-PV triggers is associated with significantly better long-term outcome than PVAI alone or PVAI+ scar homogenization.
Mohanty et al. (Mon,) conducted a cohort in Paroxysmal atrial fibrillation and severe left atrial scarring (n=177). PVAI + ablation of non-PV triggers vs. PVAI alone or PVAI + scar homogenization was evaluated on AF-free survival (success rate at the end of follow-up) (p=<0.01). PVAI plus ablation of non-PV triggers was associated with a higher success rate (61%) compared to PVAI alone (18%) or PVAI plus scar homogenization (21%) (P<0.01).