title: Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation.
abstract: OBJECTIVE
  Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers.
  
  
  RESULTS
  Totally, 177 consecutive patients with PAF and severe LA scarring were included. Patients underwent PVAI only (n = 45, Group 1), PVAI+ scar homogenization (n = 66, Group 2) or PVAI+ ablation of non-PV triggers (n = 66, Group 3) based on operator's choice. Baseline characteristics were similar across the groups. After first procedure, all patients were followed-up for a minimum of 2 years. The success rate at the end of the follow-up was 18% (8 pts), 21% (14 pts), and 61% (40 pts) in Groups 1, 2, and 3, respectively. Cumulative probability of AF-free survival was significantly higher in Group 3 (overall log-rank P <0.01, pairwise comparison 1 vs. 3 and 2 vs. 3 P < 0.01). During repeat procedures, non-PV triggers were ablated in all. After average 1.5 procedures, the success rates were 28 (62%), 41 (62%), and 56 (85%) in Groups 1, 2, and 3, respectively (log-rank P< 0.001).
  
  
  CONCLUSIONS
  In patients with PAF and severe LA scarring, PVAI+ ablation of non-PV triggers is associated with significantly better long-term outcome than PVAI alone or PVAI+ scar homogenization.
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.|Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.|Department of Medicine (Cardiology), Albert Einstein College of Medicine, Montefiore Hospital, New York, NY, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.affiliation: California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Eli Hamilton
authors.initials: EH
authors.lastname: Morris
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: Carola
authors.initials: C
authors.lastname: Gianni
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.|Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.|Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hranitzky
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: G Joseph
authors.initials: GJ
authors.lastname: Gallinghouse
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: Rodney P
authors.initials: RP
authors.lastname: Horton
authors.affiliation: California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.affiliation: California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.affiliation: Department of cardiovascular medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.affiliation: Center for Excellence in AF and Complex Arrhythmias, University of Kansas, Kansas City, KS, USA.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: Center for Excellence in AF and Complex Arrhythmias, University of Kansas, Kansas City, KS, USA.
authors.forename: Yaruva
authors.initials: Y
authors.lastname: Madhu Reddy
authors.affiliation: Department of Medicine (Cardiology), University of Miami Hospital, Miami, FL, USA.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles Gonzalez
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.affiliation: Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.|Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA.|California Pacific Medical Center, San Francisco, CA, USA.|Scripps Clinic, San Diego, CA, USA.|Division of Cardiology, Stanford University, Palo Alto, CA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002921:Cicatrix / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Left atrial scar; Non-pulmonary vein triggers; Paroxysmal atrial fibrillation; Pulmonary vein antrum isolation; Scar homogenization