title: Efficacy of adjuvant anterior left atrial ablation during intracardiac echocardiography-guided pulmonary vein antrum isolation for atrial fibrillation.
abstract: BACKGROUND
  Recent data have shown that the septum and anterior left atrial (LA) wall may contain "rotor" sites required for AF maintenance. However, whether adding ablation of such sites to standard ICE-guided PVAI improves outcome is not well known.
  
  
  OBJECTIVE
  To determine if adjuvant anterior LA ablation during PVAI improves the cure rate of paroxysmal and permanent AF.
  
  
  METHODS
  One hundred AF patients (60 paroxysmal, 40 persistent/permanent) undergoing first-time PVAI were enrolled over three months to receive adjuvant anterior LA ablation (Group I). These patients were compared with 100 randomly selected, matched first-time PVAI controls from the preceding three months who did not receive adjuvant ablation (Group II). All 200 patients underwent ICE-guided PVAI during which all four PV antra and SVC were isolated. In group I, a decapolar lasso catheter was used to map the septum and anterior LA wall during AF (induced or spontaneous) for continuous high-frequency, fractionated electrograms (CFAE). Sites where CFAE were identified were ablated until the local EGM was eliminated. A complete anterior line of block was not a requisite endpoint. Patients were followed up for 12 months. Recurrence was assessed post-PVAI by symptoms, clinic visits, and Holter at 3, 6, and 12 months. Patients also wore rhythm transmitters for the first 3 months. Recurrence was any AF/AFL >1 min occurring >2 months post-PVAI.
  
  
  RESULTS
  Patients (age 56 +/- 11 years, 37% female, EF 53%+/- 11%) did not differ in baseline characteristics between group I and II by design. Group I patients had longer procedure time (188 +/- 45 min vs 162 +/- 37 min) and RF duration (57 +/- 12 min vs 44 +/- 20 min) than group II (P < 0.05 for both). Overall recurrence occurred in 15/100 (15%) in group I and 20/100 (20%) in group II (P = 0.054). Success rates did not differ for paroxysmal patients between group I and II (87% vs 85%, respectively). However, for persistent/permanent patients, group I had a higher success rate compared with group II (82% vs 72%, P = 0.047).
  
  
  CONCLUSIONS
  Adjuvant anterior LA ablation does not appear to impact procedural outcome in patients with paroxysmal AF but may offer benefit to patients with persistent/permanent AF.
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Tamer
authors.initials: T
authors.lastname: Famy
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: S Claude
authors.initials: SC
authors.lastname: Elayi
authors.forename: Dhanumjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cummings
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Tchou
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D004452:Echocardiography / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome