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Cited 24 time in webofscience Cited 26 time in scopus
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The Electrical Isolation of the Left Atrial Posterior Wall in Catheter Ablation of Persistent Atrial Fibrillation

Authors
Lee, Jung MyungShim, JaeminPark, JunbeomYu, Hee TaeKim, Tae-HoonPark, Jin-KyuUhm, Jae-SunKim, Jin-BaeJoung, BoyoungLee, Moon-HyoungKim, Young-HoonPak, Hui-Nam
Issue Date
Nov-2019
Publisher
Elsevier USA
Keywords
catheter ablation; linear ablation; persistent atrial fibrillation; recurrence
Citation
JACC: Clinical Electrophysiology, v.5, no.11, pp 1253 - 1261
Pages
9
Indexed
SCOPUS
Journal Title
JACC: Clinical Electrophysiology
Volume
5
Number
11
Start Page
1253
End Page
1261
URI
https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/12319
DOI
10.1016/j.jacep.2019.08.021
ISSN
2405-5018
2405-500X
Abstract
Objectives This study explored whether complete electrical isolation of the left atrial (LA) posterior wall improves the rhythm outcome of catheter ablation of persistent atrial fibrillation (AF). Background Although the STAR AF2 (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II) proved no additional benefit of empirical extra-pulmonary vein (PV) LA ablation, the long-term recurrence rate after circumferential PV isolation (CPVI) alone remains high. Methods We randomly assigned 217 patients with persistent AF (83.1% men, age 58.7 ± 10.8 years, 73.3% long-standing persistent AF) to ablation with CPVI alone (CPVI group) or CPVI with a POsterior wall Box Isolation (POBI group). The endpoint of the POBI group was the elimination of the posterior atrial potentials by roof and posterior inferior lines and touch-up focal ablation. Results After a mean follow-up of 16.2 ± 8.8 months, the clinical recurrence rate did not significantly differ between the 2 groups (23.8% vs. 26.5%; p = 0.779) in the CPVI and POBI groups. The recurrence rate for atrial tachycardias (16.0% vs. 11.1%; p = 0.913) and cardioversion rates (6.7% vs. 13.7%; p = 0.093) to control clinical recurrences also did not significantly differ between the 2 groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 50.5% and 55.9% in the CPVI and POBI groups, respectively (p = 0.522). No significant difference was found in the major complication rates between the 2 groups, but the total ablation time was significantly longer in the POBI group (4,289 ± 1,837 s vs. 5,365 ± 2,358 s; p < 0.001). Conclusions In patients with persistent AF, an empirical complete POBI did not improve the rhythm outcome of catheter ablation or influence the type of recurrent atrial arrhythmia. (Comparison of Circumferential Pulmonary Vein Isolation Alone Versus Linear Ablation in Addition to Circumferential Pulmonary Vein Isolation for Catheter Ablation in Persistent Atrial Fibrillation: Prospective Randomized Controlled Trial; NCT02721121).
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