1
|
Omuro T, Yoshiga Y, Fukuda M, Kato T, Fujii S, Ueyama T, Shimizu A, Yano M. The impact of an empiric superior vena cava isolation added to pulmonary vein isolation for non-paroxysmal atrial fibrillation associated with left atrial low voltage areas. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Left atrial low-voltage areas (LVAs) are associated with recurrence after radiofrequency catheter ablation of atrial fibrillation (AF). However, the impact of LVAs on recurrence after an empiric pulmonary vein isolation (PVI) plus superior vena cava isolation (SVCI) strategy for non-Paroxysmal AF (PAF) patients remains unclear.
Purpose
We evaluated the impact of LVAs on the recurrence of atrial tachyarrhythmias (ATs)/AF in patients who underwent an empiric SVCI added to the PVI for non-PAF.
Methods
We enrolled 153 consecutive patients with non-PAF who underwent a PVI alone (PVI group; n=51) or empiric PVI plus SVCI (PVI+SVCI group; n=102). Left atrial voltage maps were constructed during sinus rhythm to identify the LVAs (<0.5 mV). No patients underwent a substrate modification of the LVAs. We divided the patients into two groups based on the LVAs (with or without an LVA >5% of the left atrial surface area) and investigated the ATs/AF free survival rate after the initial and multiple procedures.
Results
LVAs were identified in 65% and 73% of the PVI and PVI + SVCI groups, respectively (P=0.319). In the PVI group, the 18-month ATs/AF-free survival was 61% of the patients without LVAs and 27% of patients with LVAs after the initial session (P=0.018) (Figure 1-A). Seventy-two percent of the patients without LVAs and 46% of those with LVAs were free from ATs/AF after multiple sessions (P=0.083) (Figure 1-B). In the PVI+SVCI group, 50% of the patients with LVAs and 61% of those without LVAs had no recurrence after the initial session (P=0.374) (Figure 2-A). Moreover, there was no significant difference in the 18-month ATs/AF-free survival between the patients with and without LVAs after multiple sessions (73% vs. 79%; P=0.520) (Figure 2-B).
Conclusion
A PVI alone strategy for non-PAF patients with LVAs had limited efficacy for the outcomes, even with multiple procedures. However, an SVCI may have the potential to compensate for an impaired outcome in patients with LVAs.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- T Omuro
- Yamaguchi University Graduate School of Medicine, Department of Clinical Laboratory Sciences, Ube, Japan
| | - Y Yoshiga
- Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan
| | - M Fukuda
- Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan
| | - T Kato
- Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan
| | - S Fujii
- Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan
| | - T Ueyama
- Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan
| | - A Shimizu
- Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - M Yano
- Yamaguchi University Graduate School of Medicine, Department of Medicine and Clinical Science, Ube, Japan
| |
Collapse
|
2
|
Omuro T, Yoshiga Y, Shimizu A, Ueyama T, Ono M, Ishiguchi H, Yano M. P1731The distribution and predictors of left atrial low voltage zone in patients with atrial fibrillation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|