Pulmonary vein isolation alone versus pulmonary vein isolation with additional extensive ablation for paroxysmal and persistent atrial fibrillation. Issue 4 (2nd May 2022) - Junarta, Joey
Abstract: Background: The value of additional ablation beyond pulmonary vein isolation for atrial fibrillation (AF) ablation is unclear, especially for persistent AF. It is uncertain whether substrate modification with additional extensive ablation improves outcomes. We reviewed our experience to determine whether pulmonary vein isolation with additional extensive ablation (PVIEA) improves outcomes compared to pulmonary vein isolation alone (PVIA) for AF ablation. Methods: Consecutive cases of patients with PVIA versus PVIEA were compared between September 9, 2013 and December 12, 2020. Procedural data collected include radiofrequency ablation delivery time (RADT) and arrhythmia inducibility. Clinical data collected include sinus rhythm maintenance post‐procedure. Results: A total of 235 patients were studied (67 PVIA and 168 PVIEA). RADT was shorter when comparing ablation with PVIA versus PVIEA (32 vs. 40 min; p = .04). More arrhythmias were inducible with PVIEA ( p < .01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log‐rank test p = .75), after 3 or 12 months between groups overall, and when stratified by AF type (paroxysmal and persistent), left atrial volume, CHA2 DS2 ‐VASc score, left ventricular ejection fraction, or catheter ablation setting (high‐power short‐duration, standard‐power standard‐duration, temperature‐controlled non‐contact‐force). Conclusion: AF ablation with PVIA or PVIEA produces similar sinus rhythm maintenance overall and when stratified by catheter setting and AF type. PVIA reduced procedure times and less arrhythmias were inducible post‐ablation. Abstract : Although pulmonary vein isolation alone likely undertreats persistent atrial fibrillation, conventional substrate modification has not been shown to improve rhythm outcomes. Alternative strategies of substrate modification or alternative energy sources may be the key to improving outcomes in those with persistent atrial fibrillation.