Long‐Term Outcome of Left Atrial Voltage‐Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy

Yagishita, Atsuhiko; Gimbel, John; Oliveira, Samer De; Manyam, Harish; Sparano, Dina M.; Cakulev, Ivan; Mackall, Judith A.; Arruda, Maurício

doi:10.1111/jce.13122

Cited by 77 publications

(90 citation statements)

References 41 publications

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“…Intrinsically, all LVAs may not always be ablated for the modification. This study also indicated that the LVAs after the PVI were not an independent predictor for AF recurrence as described previously . Excessive lesion sets for substrate modification may lead to totally new atrial arrhythmias .…”

Section: Discussionsupporting

confidence: 83%

Evaluation of the atrial substrate based on low‐voltage areas and dominant frequencies after pulmonary vein isolation in nonparoxysmal atrial fibrillation

Kumagai

Minami

Sugai

2018

Journal of Arrhythmia

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BackgroundThis study aimed to evaluate the atrial substrate in the left atrium (LA) by low‐voltage areas (LVAs) and high‐dominant frequencies (DFs) after circumferential pulmonary vein isolation (PVI) in nonparoxysmal atrial fibrillation (AF).MethodsIn 70 patients with nonparoxysmal AF patients (41 persistent AF), LA voltage maps were created during sinus rhythm by external cardioversion after PVI and DF mapping. The patients were divided into AF‐free and AF‐recurrent groups.ResultsThe AF freedom rate without antiarrhythmic drugs was 69.0% after PVI after 1 procedure during a 12‐month follow‐up. There was a significant difference in the LVA (<0.5 mV)/LA surface area after PVI between the AF‐free and AF‐recurrent groups (15% vs 23%, P = .033). AF freedom was significantly greater in those with LVAs of ≤24% than in those with LVAs of >24% during 12 months of follow‐up (78.6% vs 53.8%, Log‐rank test P = .020). Fifty‐six (72%) of the 78 high‐DF sites (≥8 Hz) overlapped with LVAs. Thirty‐one (55%) of 56 high‐DF sites overlapped with LVAs that existed at LVA border zones. There were no significant differences in number of high‐DF sites that overlapped with LVAs in the LA between the two groups. However, in persistent AF patients, the max‐DF value in the LA exhibited a significant difference between the two groups (P = .008).Conclusions LVAs were associated with AF recurrences after PVI in nonparoxysmal AF patients and overlapped with many high‐DF sites. PVI alone may be enough to treat patients with mild‐to‐moderate extent (≤24%) of LVAs.

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Section: Discussionsupporting

confidence: 83%

Evaluation of the atrial substrate based on low‐voltage areas and dominant frequencies after pulmonary vein isolation in nonparoxysmal atrial fibrillation

Kumagai

Minami

Sugai

2018

Journal of Arrhythmia

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“…Different study groups reported lower success rates of AF ablation procedures in women . Delayed referrals and therefore a higher age and comorbidity were discussed . In our BIFA population, females were also older (70.1 ± 6.1 vs. 66.4 ± 8.7, P = 0.026), so a somewhat advanced atrial disease would be possible if progression is assumed.…”

Section: Discussionmentioning

confidence: 84%

“…Yagishita et al. reported about 60% of PAF patients showing some type of low voltage areas, with good results after substrate based ablation; however, in this study group EAVM was performed during AF …”

Section: Discussionmentioning

confidence: 99%

Catheter ablation of atrial fibrillation with box isolation of fibrotic areas: Lessons on fibrosis distribution and extent, clinical characteristics, and their impact on long‐term outcome

Schreiber

Rieger

Moser

et al. 2017

Cardiovasc electrophysiol

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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.

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“…In many patients with AF, individually located sites and/or patchy fibrotic areas targeted specifically for ablation have been found. However, in some patients with AF having diffuse, massive fibrosis, there seem to be no apparent curative ablation approaches . The approaches include ablative homogenization of the LVAs, encircling of the LVAs for isolation, and linear lesions from the isolated LVAs connecting them to anatomic structures to prevent AT .…”

Section: Discussionmentioning

confidence: 99%

Effect of ablation at high‐dominant frequency sites overlapping with low‐voltage areas after pulmonary vein isolation of nonparoxysmal atrial fibrillation

Kumagai

Minami

Sugai

et al. 2019

Cardiovasc electrophysiol

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Background The relationship between high‐dominant frequency (DF) sites and low‐voltage areas (LVAs) in nonparoxysmal atrial fibrillation (AF) patients still remains unknown. Objective This study aimed to evaluate the effect of ablation at high‐DF sites overlapping with LVAs after pulmonary vein ablation (PVI) of nonparoxysmal AF. Methods A total of 128 consecutive nonparoxysmal patients with atrial fibrillation (53 persistent AF) were retrospectively investigated. The patients with AF were divided into two groups: patients with circumferential PVI alone (PVI group, n = 57) and those with PVI followed by a DF‐based ablation (DF group, n = 71). Results The patient characteristics did not significantly differ between the two groups. However, the LVA ( < 0.5 mV)/left atrial (LA) surface was significantly greater in the DF than the PVI group (22% vs 16%, P = .02). The total max‐DF sites overlapping with LVAs in the LA were significantly greater in the DF than the PVI group (91% vs 10%, P = .001). The atrial arrhythmia freedom on antiarrhythmic drugs in the DF group was significantly greater than that in the PVI group during 10.0 ± 3.2 months of follow‐up (83.1% vs 64.9%, log‐rank test P = .021). The event‐free survival in the PVI group decreased according to the LVA extent while it was > 80% in the DF group. The event‐free survival in patients with AF especially with extensive LVAs ( ≥ 30%) in the DF group was significantly greater than that in the PVI group (81.0% vs 45.5%, log‐rank test P = .035). Conclusions High‐DF sites overlapping with LVAs after the PVI may be potential selective targets for modification of atrial substrates in nonparoxysmal AF patients.

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Long‐Term Outcome of Left Atrial Voltage‐Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy

Abstract: Patients with LVA had an equally favorable long-term ablation outcome compared to those without. As an adjunct to PVI, voltage-guided substrate modification may be an important ablation strategy in patients with LA structural remodeling.

Cited by 77 publications

References 41 publications

Evaluation of the atrial substrate based on low‐voltage areas and dominant frequencies after pulmonary vein isolation in nonparoxysmal atrial fibrillation

Evaluation of the atrial substrate based on low‐voltage areas and dominant frequencies after pulmonary vein isolation in nonparoxysmal atrial fibrillation

Catheter ablation of atrial fibrillation with box isolation of fibrotic areas: Lessons on fibrosis distribution and extent, clinical characteristics, and their impact on long‐term outcome

Effect of ablation at high‐dominant frequency sites overlapping with low‐voltage areas after pulmonary vein isolation of nonparoxysmal atrial fibrillation

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