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Challenging Achievement of Bidirectional Block After Linear Ablation Affects the Rhythm Outcome in Patients With Persistent Atrial Fibrillation

Title
Challenging Achievement of Bidirectional Block After Linear Ablation Affects the Rhythm Outcome in Patients With Persistent Atrial Fibrillation
Authors
Kim, Tae-HoonPark, JunbeomUhm, Jae-SunKim, Jong-YounJoung, BoyoungLee, Moon-HyoungPak, Hui-Nam
Ewha Authors
박준범
SCOPUS Author ID
박준범scopus
Issue Date
2016
Journal Title
JOURNAL OF THE AMERICAN HEART ASSOCIATION
ISSN
2047-9980JCR Link
Citation
vol. 5, no. 10
Keywords
atrial fibrillationcatheter ablationlinear ablationposterior wall isolation
Publisher
WILEY-BLACKWELL
Indexed
SCIE; SCOPUS WOS scopus
Abstract
Background-It is not clear whether bidirectional block (BDB) of linear ablations reduces atrial fibrillation (AF) recurrence after radiofrequency catheter ablation. We hypothesized that BDB of linear ablation has prognostic significance after radiofrequency catheter ablation for persistent AF. Methods and Results-Among 1793 consecutive patients in the Yonsei AF ablation cohort, this observational cohort study included 398 patients with persistent AF (75.6% male; age, 59.8 +/- 10.3 years) who underwent catheter ablation with a consistent ablation protocol of the Dallas lesion set: circumferential pulmonary vein isolation; cavotricuspid isthmus ablation (CTI); roof line (RL); posterior-inferior line (PIL); and anterior line (AL). BDB rates of de novo ablation lines were 100% in circumferential pulmonary vein isolation, 100% in CTI, 84.7% in RL, 44.7% in PIL, and 63.6% in AL. During 29.0 +/- 18.4 months of follow-up, 31.7% (126/398) of the patients showed clinical recurrence. Left atrial posterior wall (LAPW) isolation (BDBs of RL and PIL) was independently associated with lower clinical AF/atrial tachycardia recurrence (hazard ratio, 0.68; 95% CI, 0.47-0.98; P=0.041; log-rank, P=0.017), whereas BDBs of RL or AL were not (log-rank, P=0.178 for RL; P=0.764 for AL). Among 52 patients who underwent repeat procedures (23.0 +/- 16.1 months after de novo procedure), the BDB maintenance rates for CTI, RL, PIL, and AL were 94.2% (49 of 52), 63.5% (33 of 47), 62.1% (18 of 29), and 61.8% (21 of 34), respectively. Conclusions-Although PIL crosses the esophageal contact area, LAPW isolation is important for better clinical outcome in catheter ablation with a linear ablation strategy for patients with persistent AF.
DOI
10.1161/JAHA.116.003894
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의학전문대학원 > 의학과 > Journal papers
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