In patients with atrial fibrillation and fibrotic atrial cardiomyopathy, PVI plus box isolation of fibrotic areas achieved single and multiple procedure success rates of 69% and 83% at 16 months.
Cohort (n=92)
Does pulmonary vein isolation supplemented with box isolation of fibrotic areas improve outcomes in atrial fibrillation patients with fibrotic atrial cardiomyopathy?
In AF patients with fibrotic atrial cardiomyopathy, supplementing PVI with box isolation of fibrotic areas achieves 83% multiple-procedure success, though extensive fibrosis predicts worse outcomes.
Abstract Introduction The BIFA concept (box isolation of fibrotic areas) supplementing pulmonary vein isolation (PVI) was implemented in atrial fibrillation (AF) patients with fibrotic atrial cardiomyopathy (FACM) to improve catheter ablation outcomes. Methods and results Ninety‐two patients with FACM underwent PVI + BIFA. We investigated patient characteristics (58 persistent/34 paroxysmal, 68 ± 8 years, LA 44 ± 7 mm, CHA 2 DS 2 ‐VASc 2.6 ± 1.3, FACM I: 15.2%, II: 53.3%, III: 26.1%, IV: 5.4%), periprocedural data concerning fibrosis extent/distribution, and their impact on outcome. Based on severe fibrosis areas (SFAs) of 13.5 ± 13.9 cm 2 detected by voltage mapping, 1.4 ± 0.5 boxes (n = 1–3, 2.2–35.3 cm 2 ) were applied in the left atrium. With higher grade FACM, SFAs increased and maximum voltage decreased (I/IV: 6.29/3.18 mV). Anterior (ant.) SFAs were found to be more common and larger than posterior (post.) SFAs (58.3% vs. 42.6%, ant. 8.0 ± 8.0 vs. post. 4.7 ± 6.8 cm 2 ). In 40 of 92 (43%) patients, both atrial walls were affected with rare cases of solely post. fibrosis (6 of 92, 6.6%). Women (39 of 92, 42%) showed FACM III+IV more often than men (P = 0.022) and can still present paroxysmal while persistent males are more likely to have FACM I‐II. Single and multiple procedure (1.2/patient) success was 69% and 83% after 16 ± 8 months with an unfavorable impact of large SFA size, both‐sided fibrosis and reduced maximum voltage, independently of patient characteristics and AF type. Conclusion FACM patients are a challenging AF subgroup for catheter ablation. Women seem to show FACM III+IV more often than men. The distribution of left atrial fibrosis is variable but more pronounced anteriorly. Atrial disease is characterized by SFA size but also maximum voltage reduction, both with implications on ablation outcome. Using BIFA, success rates of patients without fibrosis can be approached but are limited in FACM III+IV.
Schreiber et al. (Wed,) conducted a cohort in Atrial fibrillation with fibrotic atrial cardiomyopathy (n=92). Pulmonary vein isolation plus box isolation of fibrotic areas (PVI + BIFA) was evaluated on Single and multiple procedure success. In patients with atrial fibrillation and fibrotic atrial cardiomyopathy, PVI plus box isolation of fibrotic areas achieved single and multiple procedure success rates of 69% and 83% at 16 months.