Clinical Predictors of Termination and Clinical Outcome of Catheter Ablation for Persistent Atrial Fibrillation

Matsuo, Seiichiro; Lellouche, Nicolas; Wright, Matthew; Bevilacqua, Michela; Knecht, Sébastien; Nault, Isabelle; Lim, Kang‐Teng; Arantès, Leonardo; O’Neill, Mark; Platonov, Pyotr G.; Carlson, Jonas; Sacher, Frédéric; Hocini, Mélèze; Jaı̈s, Pierre; Haı̈ssaguerre, Michel

doi:10.1016/j.jacc.2009.01.081

Cited by 176 publications

(151 citation statements)

References 26 publications

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“…Of note, we observed only a modest rate (about 60%) of patients in whom AF terminated during ablation, 11 although most of the studies which document a positive influence of AF termination had a higher conversion rate (66%-84%). 16,[20][21][22] Our low rate of AF termination might be explained by the high number of patients with long-standing persistent AF in our cohort because a long persistence of AF is considered a negative predictor for AF termination during ablation. 22 …”

Section: Conversion Of Af and Arrhythmia Recurrencementioning

confidence: 96%

“…Several single-arm registries reported that conversion of AF (to SR or AT) during ablation impacted positively on longterm clinical success, 16,17,[20][21][22] whereas others, including the randomized CHASE-AF trial, did not demonstrate a beneficial impact of AF conversion. 11,15 In our analysis, conversion of AF was not associated with a superior clinical outcome.…”

Section: Conversion Of Af and Arrhythmia Recurrencementioning

confidence: 99%

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Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

Fink

Schlüter

Heeger

et al. 2017

Circ: Arrhythmia and Electrophysiology

150

105

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C atheter ablation has become a routine treatment option for patients experiencing symptomatic paroxysmal atrial fibrillation (AF). Long-term clinical success rates of ≤80% after 5 years have been reported for the treatment of paroxysmal AF by initial stand-alone pulmonary vein isolation (PVI) as the accepted cornerstone of all AF ablation strategies; however, to achieve permanent PVI, multiple procedures are often required. 1,2 In contrast, the results for ablation of persistent AF are less convincing. 3 The optimal strategy for persistent AF is not known, and previous studies investigating more extensive ablation strategies in addition to PVI demonstrated heterogeneous results. [4][5][6][7][8][9][10][11][12] The recently published STAR AF 2 trial (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial) compared initial stand-alone PVI to PVI with additional ablation of complex fractionated atrial electrograms (CFAEs) or additional linear ablation and could not demonstrate a superior outcome for the additional ablation strategies. 13 The prospective and randomized Alster-Lost-AF © 2017 American Heart Association, Inc. Original ArticleBackground-Pulmonary vein isolation (PVI) for persistent atrial fibrillation is associated with limited success rates and often requires multiple procedures to maintain stable sinus rhythm. In the prospective and randomized Alster-Lost-AF trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation), we sought to assess, in patients with symptomatic persistent or long-standing persistent atrial fibrillation, the outcomes of initial ablative strategies comprising either stand-alone PVI (PVI-only approach) or a stepwise approach of PVI followed by complex fractionated atrial electrogram ablation and linear ablation (Substrate-modification approach). Methods and Results-Patients were randomized 1:1 to stand-alone PVI or PVI plus substrate modification. The primary study end point was freedom from recurrence of any atrial tachyarrhythmia, outside a 90-day blanking period, at 12 months. A total of 124 patients were enrolled, with 118 patients included in the analysis (61 in the PVI-only group, 57 in the Substrate-modification group). Atrial tachyarrhythmias recurred in 28 PVI-only group patients and 24 Substratemodification group patients, for 1-year freedom from tachyarrhythmia recurrence after a single ablation procedure of 54% (95% confidence interval, 43%-68%) in the PVI-only and 57% (95% confidence interval, 46%-72%) in the Substratemodification group (P=0.86). Twenty-four patients in the PVI-only group (39%) and 18 in the Substrate-modification group (32%) were without arrhythmia recurrence and off antiarrhythmic drug therapy at the end of the 12-month follow-up. Conclusions-In

show abstract

Section: Conversion Of Af and Arrhythmia Recurrencementioning

confidence: 96%

Section: Conversion Of Af and Arrhythmia Recurrencementioning

confidence: 99%

Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

Fink

Schlüter

Heeger

et al. 2017

Circ: Arrhythmia and Electrophysiology

150

105

View full text Add to dashboard Cite

show abstract

“…3 Further, as non-invasive pre-procedural predictors of the termination of persistent AF, the AFCL from the surface electrocardiogram (ECG) and duration of the continuous AF have been reported to be clinically useful as a pre-ablation tool for predicting the patients in whom SR can be restored by ablation. 5 Clinical prediction of the procedural and clinical outcomes of ablation in patients with persistent AF, however, have not been fully evaluated. In contrast, in the Prediction of AF Termination ostia and a deflectable ablation catheter in the LA through the LA sheath.…”

Section: Editorial P 1399mentioning

confidence: 99%

“…AF recurrence was defined as sustained AF lasting >3 min. 5 Repeat ablation was performed in the event of recurrence of AF or AT lasting >3 min.…”

Section: Clinical Characteristics and Outcomementioning

confidence: 99%

Pre-Procedural Prediction of Termination of Persistent Atrial Fibrillation by Catheter Ablation as an Indicator of Reverse Remodeling of the Left Atrium

Kumagai

Sakamoto

Nakamura

et al. 2013

Circ J

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“…8 Perhaps the more advanced underlying electrical and structural remodeling due to longer AF duration (> 2 years) in patients from the Elayi series portends a greater prognostic burden than achieving termination of AF during catheter ablation. This may in part account for their observations that atrial tachycardias of a focal mechanism had a better outcome than those of a re-entrant type given the complex atrial substrate in their patients as evidenced by their short baseline AF cycle length further alluding to their arrhythmia chronicity.…”

Section: Journal Of Atrial Fibrillation Editorialmentioning

confidence: 99%

AF Termination: the Holy Grail of Persistent AF Ablation?

Sanders¹,

Lau²,

Brooks³

2010

J.A.F.I.B

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The optimal catheter ablation approach for long-standing persistent atrial fibrillation (AF) remains elusive despite significant advances made in our understanding of this arrhythmia. A recent systematic review highlighted the significant variation in procedural success rate both within and between techniques, necessitating repeat ablation procedures and anti-arrhythmic drugs to achieve improved outcomes in those with long-standing persistent AF . Indeed, current expert consensus statement recommended ablation beyond ostial pulmonary vein isolation for these patients . Despite incorporating various substrate modification techniques which commonly include linear lesions and targeting of complex fractionated electrograms, the reported success rates from various laboratories are still below par to those in paroxysmal AF patients

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Clinical Predictors of Termination and Clinical Outcome of Catheter Ablation for Persistent Atrial Fibrillation

Abstract: The surface ECG AFCL is a clinically useful pre-ablation tool for predicting patients in whom sinus rhythm can be restored by catheter ablation. The duration of continuous AF and the surface ECG AFCL are predictive of maintenance of sinus rhythm.

Cited by 176 publications

References 26 publications

Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

Pre-Procedural Prediction of Termination of Persistent Atrial Fibrillation by Catheter Ablation as an Indicator of Reverse Remodeling of the Left Atrium

AF Termination: the Holy Grail of Persistent AF Ablation?

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