Difference in the maintenance mechanism of atrial fibrillation perpetuated after pulmonary vein isolation between paroxysmal and persistent atrial fibrillation: Effects of subsequent stepwise ablation. (1st May 2016)

• Record Type: Journal Article
• Authors: Yamabe, Hiroshige; Kanazawa, Hisanori; Itoh, Miwa; Kaneko, Shozo; Ogawa, Hisao
• Is Part Of: International journal of cardiology. Volume 210(2016)
• Page Start: 109
• Page End: 118
• Publication Date: 2016-05-01
• Subjects: AF atrial fibrillation -- AFL atrial flutter -- AT atrial tachycardia -- CFAE complex fractionated atrial electrogram -- FIRM focal impulse and rotor modulation -- LA left atrium -- P-AF paroxysmal AF -- Per-AF persistent AF -- PV pulmonary vein -- PVI pulmonary vein isolation; Atrial fibrillation -- Catheter ablation -- Reentry -- Mapping; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.02.092
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Neither the atrial fibrillation (AF) maintenance mechanism after pulmonary vein isolation (PVI) nor the mechanism of AF termination via stepwise ablation is clearly understood. Methods: Among 226 consecutive AF patients (154 paroxysmal (P-AF) and 72 persistent AF (Per-AF) patients), left atrial endocardial non-contact mapping was performed after PVI in the initial 10 P-AF and 16 Per-AF patients to define the AF maintenance mechanism. Subsequently, effect of stepwise catheter ablation (linear roof lesion and complex fractionated atrial electrogram (CFAE) following PVI) was evaluated in all patients. Results: After PVI, AF was maintained by the activation around isolated PV/mitral annulus, focal discharge and disorganized activations mostly observed over residual CFAE region (pivoting activation, wave break and fusion). CFAE region in P-AF was smaller than Per-AF after PVI (1.6 ± 2.1 vs. 7.7 ± 2.5 cm 2, p < 0.0001). The frequency of pivoting activation, wave break and fusion in P-AF were lower than those in Per-AF (1.9 ± 2.0 vs. 11.8 ± 5.0 times/s; p < 0.0001, 0.1 ± 0.3 vs. 3.6 ± 2.5 times/s; p < 0.001, 5.8 ± 3.6 vs. 9.8 ± 3.2 times/s; p < 0.01). AF termination was more frequent in P-AF than Per-AF (94.8% vs 81.9%, p = 0.0019). AF termination by PVI alone was more frequent in P-AF than Per-AF (85.6% vs. 18.6%, p < 0.0001). However, AF termination via roof line and/or CFAE ablation was less frequent in P-AF than Per-AF (14.4 vs. 81.4%, p < 0.0001). Conclusions: Disorganized activations after PVI, more prominent in Per-AF, were associated with residual CFAE region. Most P-AF was terminated by PVI alone, however additional roof line lesion and CFAE ablation were necessary to terminate Per-AF, consistent with mapping results.