Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

Abstract

Background: Empirical posterior wall isolation (PWI) has been proposed as a treatment in patients with non-paroxysmal atrial fibrillation (AF). A few randomized clinical trials have failed to prove any benefit of PWI probably due to inappropriate ablation techniques. Epicardial connections in the PW have recently been shown to play an important arrhythmogenic role.
Objective: We aimed to compare success rate between two approaches of catheter ablation for non-paroxysmal AF: Pulmonary vein isolation (PVI) alone versus PVI plus PWI using a novel technique for PWI.
Methods: First, we isolated the PW with two lines connecting the superior and inferior pulmonary vein. Subsequently, high out pacing (20mA/2ms) was performed inside the PW. If myocardial capture was present, additional radiofrequency lesions were made until achieving unexcitability.
Results: We conducted a retrospective analysis of patients who underwent PVI alone and PVI + PWI. (here we have to add briefly how we isolated the pw and using high output pacing , copy from plea trial). We used propensity score matching using a multivariable logistic regression model with PWI as the dependent variable. We originally included a total of 1,776 patients (PVI: 580/PVI+PWI: 1,196). After performing 1:1 matching for all baseline characteristics, echocardiographic parameters, the study was finally conducted in 600 patients (PVI: 300 patients, mean age 63.5, 46% male; PVI+PWI: 300 patients, mean age 62.1, 45.3% male). The acute success rate was 100% in both groups. The overall freedom from all-atrial arrhythmia recurrence at 12 months follow-up in patients who underwent PVI plus PWI was 80% vs. 61% in those who underwent PVI alone (19% absolute reduction, p= 0.001). There was no significant difference in acute and long-term complications between both groups.
Conclusion: Our study suggests that PWI in addition to PVI provides a substantial incremental benefit in achieving freedom from all-atrial arrhythmias in patients with non-paroxysmal AF when compared to PVI alone. A more extensive ablation approach in the PW seems to play a key role to obtain better clinical outcomes in these patients.
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