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Posterior wall isolation in persistent atrial fibrillation. Long-term outcomes of a repeat procedure strategy

Journal of Interventional Cardiac Electrophysiology, ISSN: 1572-8595, Vol: 66, Issue: 4, Page: 971-979
2023
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New Atrial Fibrillation Study Findings Recently Were Reported by Researchers at Copenhagen University Hospital Gentofte (Posterior Wall Isolation In Persistent Atrial Fibrillation. Long-term Outcomes of a Repeat Procedure Strategy)

2022 DEC 02 (NewsRx) -- By a News Reporter-Staff News Editor at NewsRx Cardiovascular Daily -- A new study on Heart Disorders and Diseases -

Article Description

Background: Posterior wall isolation (PWI) added to pulmonary vein isolation (PVI) is increasingly used in ablation for persistent atrial fibrillation (PeAF) despite limited evidence of clinical benefit. We investigated the 5-year outcomes of a PVI + PWI ablation strategy with mandatory repeat procedures in PeAF. Methods: Twenty-four patients with PeAF participated in this single-arm prospective study and underwent radiofrequency ablation (RFA) with wide area circumferential ablation (WACA), roof, and inferior lines for PVI + PWI which was reinforced if required during mandated repeat procedures after 6 months. Then, patients were followed for 60 months using continuous heart rhythm monitoring by implanted cardiac monitors (ICM) and atrial fibrillation effect on quality-of-life scoring (AFEQT; range: 20–100 points) for the initial 30 months. Results: ICM-verified cumulated AF recurrence was 54% after 30 months but the ensuing AF burden was only median 0‰ [0 to 4.8‰] overall and 1‰ [0 to 8 ‰] among patients with any recurrence. AFEQT scores increased from baseline 60 points [48 to 72] to 93 points [84 to 96] at repeat procedures P < 0.0001 and further to 96 points [93 to 99] P = 0.03 after 30 months. After 60 months, at least one episode of AF had been documented in 63% and two patients (8%) were in permanent AF. Conclusion: Reinforced PVI + PWI was associated with low long-term AF burden and corresponding improvements in quality-of-life. Reinforced (or durable) PVI + PWI appears to be a promising strategy to treat PeAF. Trial registration: ClinicalTrials.gov. Identifier: NCT05045131.

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