Optimal substrate modification strategies using catheter ablation in patients with persistent atrial fibrillation: 3‐year follow‐up outcomes

Abstract

Objectives This study aimed to assess the comparative efficacy of four ablation strategies on the incidence rates of freedom from atrial fibrillation (AF) or atrial tachycardia (AT) through a 3‐year follow‐up in patients with persistent AF. Background The optimal substrate modification strategies using catheter ablation for patients with persistent AF remain unclear. Methods Patients with persistent AF were enrolled consecutively to undergo each of four ablation strategies: (a) Group 1 (Gp 1, n = 69), pulmonary vein isolation (PVI) plus rotor ablation assisted by similarity index and phase mapping; (b) Gp 2 (n = 75), PVI plus linear ablations at the left atrium; (c) Gp 3 (n = 42), PVI plus the elimination of complex fractionated atrial electrograms; (d) Gp 4 (n = 67), PVI only. Potential confounders were adjusted via a multivariate survival parametric model. Results Baseline characteristics were similar across the four groups. At a follow‐up period of 34.9 ± 38.6 months, patients in Gp 1 showed the highest rate of freedom from AF compared with the other three groups (p = .002), while patients in Gp 3 and 4 showed lower rates of freedom from AT than those of the other two groups (p = .006). Independent predictors of recurrence of AF were the ablation strategy (p = .002) and left atrial diameter (LAD) (p = .01). Conclusion In patients with persistent AF, a substrate modification strategy using rotor ablation assisted by similarity index and phase mapping provided a benefit for maintaining sinus rhythm compared with the other strategies. Both ablation strategy and baseline LAD predicted the 3‐year outcomes of freedom from AT/AF

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

“…Their ablation resulted in atrial tachyarrhythmia freedom in 73.1% of the patients at 1-year follow-up [ 123 ]. FIRM-guided ablation may also be superior to linear left atrial ablation and CFAE ablation regarding the recurrence of AF, as shown by Hsieh et al [ 124 ]. However, a meta-analysis of head-to-head studies comparing PVI with and without FIRM-guided ablation showed no statistically significant difference in atrial tachyarrhythmia recurrence at a mean 18.8 months of follow-up [ 125 ].…”

Atrial fibrillation activation patterns predict freedom from arrhythmias after catheter ablation: utility of ExTRa mapping™

“…This method can be used to determine which active sources significantly contribute to the perpetuation of fibrillation in the atrium. However, electrical rotor ablation, which identifies and ablates the AF driver as the causative mechanism of AF, has demonstrated a wide variability in its success rates (7)(8)(9).…”