Key result
Long-term maintenance of intraprocedural ablation endpoints, such as pulmonary vein disconnection (37.5% of PVs), was limited and did not differ significantly between patients with and without AF recurrence.
Why the study?
Does the long-term maintenance of intraprocedural ablation endpoints differ between patients with stable sinus rhythm and those with atrial fibrillation recurrence?
Observational (n=30)
Does the long-term maintenance of intraprocedural ablation endpoints differ between patients with stable sinus rhythm and those with atrial fibrillation recurrence?
p-value: p=not statistically significant
Common intraprocedural ablation endpoints such as PV disconnection and voltage abatement are poorly maintained long-term, even in patients who remain in stable sinus rhythm, suggesting permanent isolation may not be strictly required for clinical success.
Limited AF ablation lesion durability in this cohort warrants caution; leaves open optimal strategies for durable isolation.
BACKGROUND: Several approaches have been developed for radiofrequency catheter ablation of atrial fibrillation, but the correct intraprocedural end point is still under debate, and few data exist about the destiny of ablation lesions over time. The aim of the present study was to evaluate the long-term maintenance of intraprocedural end points of ablation procedures. METHODS AND RESULTS: Inclusion criteria were (1) a previous ablation procedure of pulmonary vein (PV) encircling performed for drug-refractory persistent atrial fibrillation; (2) a "complete" intraprocedural end point, which consisted of voltage abatement inside the lesions, PV disconnection, and exit-block pacing from inside the lesions, attained in all PVs; and (3) stable sinus rhythm documented during a minimum follow-up of 2.5 years after the procedure. Twenty volunteers were selected (12 males, mean age 59+/-7 years) and underwent a repeat electrophysiological study. After a follow-up of 36.4+/-4.7 months, complete voltage abatement was maintained around 32 PVs (40.0%), PV disconnection persisted in 12 (37.5%) of the previously isolated PVs, and exit block was present in 39 PVs (48.7%). Ten patients who underwent a redo ablation procedure because of recurrences of atrial fibrillation were used as the control group. Differences in intraprocedural end-point maintenance between the 2 groups were not statistically significant. CONCLUSIONS: Common intraprocedural end points such as voltage abatement, PV disconnection, and exit block persist only in a limited number of patients, even when the outcome is favorable during follow-up. Further investigation will be required to determine whether such data will have implications for ablation strategies.
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Pratola et al. (2007) conducted an observational in Drug-refractory persistent atrial fibrillation (n=30). Stable sinus rhythm post-ablation vs. Recurrence of atrial fibrillation was evaluated on Maintenance of intraprocedural end points (voltage abatement, PV disconnection, and exit block) (p=not statistically significant). Long-term maintenance of intraprocedural ablation endpoints, such as pulmonary vein disconnection (37.5% of PVs), was limited and did not differ significantly between patients with and without AF recurrence.
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