Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation

被引:57
作者
Estner, Heidi Luise [1 ,2 ]
Hessling, Gabriele [1 ,2 ]
Ndrepepa, Gjin [1 ,2 ]
Wu, JinJin [1 ,2 ]
Reents, Tilko [1 ,2 ]
Fichtner, Stefanie [1 ,2 ]
Schmitt, Claus [3 ]
Bary, Christian V. [1 ,2 ]
Kolb, Christof [1 ,2 ]
Karch, Martin [3 ]
Zrenner, Bernhard [1 ,2 ]
Deisenhofer, Isabel [1 ,2 ]
机构
[1] Tech Univ Munich, Klinikum Rechts Isar, Deutsch Herzzentrum Munchen, D-80636 Munich, Germany
[2] Tech Univ Munich, Klinikum Rechts Isar, Med Klin 1, D-80636 Munich, Germany
[3] Stadt Klinikum Karlsruhe, Karlsruhe, Germany
来源
EUROPACE | 2008年 / 10卷 / 11期
关键词
Persistent atrial fibrillation; Ablation; Pulmonary vein isolation; Complex fractionated atrial electrograms;
D O I
10.1093/europace/eun244
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Ablation of complex fractionated atrial electrograms (CFAEs) is a new approach for the treatment of atrial fibrillation (AF). The purpose of the study was to assess the efficacy of CFAE ablation as a stand-alone strategy in patients with persistent AF and to compare it with a combined approach of CFAE ablation and pulmonary vein isolation (PVI). Methods and results The study included 77 consecutive patients with persistent AF who underwent radiofrequency (RF) ablation of CFAE as a sole ablation procedure (CFAE group, n = 23 patients) or a combined approach of CFAE ablation and PVI (CFAE plus PVI group, n = 54 patients). Procedures were guided by three-dimensional mapping systems. After the procedure, AF recurrences were evaluated with 7-day Holter recordings at 1, 3, and 6 months and every 6 months thereafter. Treatment failure was defined as >= 1 AF episode lasting > 30 s on Holter recordings during follow-up. After a mean follow-up time of 13 +/- 10 months, 2 of 23 patients (9%) with CFAE ablation and 22 of 54 patients (41%) with CFAE plus PVI were in sinus rhythm after a single ablation procedure without anti-arrhythmic medication (P = 0.008). Conclusion Ablation of CFAE as a stand-alone ablation strategy seems insufficient for the treatment of patients with persistent AF. Pulmonary vein isolation plus CFAE ablation significantly increases the mid-term success rate.
引用
收藏
页码:1281 / 1287
页数:7
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