title: Acute effects and long-term outcome of pulmonary vein isolation in combination with electrogram-guided substrate ablation for persistent atrial fibrillation.
abstract: Complex fractionated atrial electrographic (CFAE) catheter ablation is a new approach for the treatment of atrial fibrillation (AF). It is unclear if acute results of this approach correspond to long-term outcome. The purpose of this study was to prospectively assess acute and long-term successes of an ablation approach combining pulmonary vein isolation (PVI) and ablation of CFAE areas for treatment of persistent AF. PVI and ablation of CFAE areas were performed in 35 patients with persistent AF (30 men, 57+/-9 years of age). At the end of the ablation procedure AF had terminated in 23 of 35 patients (66%) by conversion to sinus rhythm (8 of 23 patients, 35%) or organization to atrial tachycardia (15 of 23 patients, 65%). AF persisted in 12 of 35 patients (34%). At the end of the follow-up period (19+/-12 months), sinus rhythm was present in 26 of 35 patients (74%), including 9 patients with a repeat procedure. This group of 26 patients consisted of 7 of 8 patients (88%) with acute sinus rhythm after the first ablation, 11 of 15 patients (73%) with organization, and 8 of 12 patients (66%) with ongoing AF (p=0.32). In conclusion, a combined approach of PVI and CFAE ablation in persistent AF leads to acute AF termination in 66% and long-term maintenance of sinus rhythm in 74% of cases. However, long-term outcome was not predictable by acute results of the ablation procedure.
authors.affiliation: Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. estner@dhm.mhn.de
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Estner
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Armin
authors.initials: A
authors.lastname: Luik
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Agathe
authors.initials: A
authors.lastname: Konietzko
authors.forename: Ekrem
authors.initials: E
authors.lastname: Ucer
authors.forename: JinJin
authors.initials: J
authors.lastname: Wu
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.forename: Andreas
authors.initials: A
authors.lastname: Pflaumer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zrenner
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome