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

D-PO02-136 - Benefit Of Empirical Posterior Wall Isolation And Left Atrial Appendage Electrical Isolation In Patients With Non-paroxysmal Atrial Fibrillation: A Propensity Score Matching Study (ID 1026)


Background: The benefit of empirical posterior wall isolation (PWI) and left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) has been demonstrated. Nevertheless, the optimal ablation strategy is still unknown.
Objective: We aimed to assess the incremental benefit of three different approaches of catheter ablation for non-paroxysmal AF: pulmonary vein isolation (PVI) alone vs. PVI/PWI vs. PVI/PW/LAAEI.
Methods: We conducted a retrospective analysis of patients who underwent PVI alone, PVI + PWI and PVI + PWI + LAAEI. We used propensity score matching using a multivariable logistic regression model with PWI and LAAEI as the dependent variables. Baseline characteristics and procedural ablation techniques were used as covariates. Matching (1:1:1) was performed without replacement and with a caliper of 0.03 of the standard deviation.
Results: We originally included a total of 432 patients (PVI:223; PVI+PWI:140; PVI+PWI+LAAEI:69). After performing 1:1:1 matching for all baseline characteristics, echocardiographic parameters, the study was finally conducted in 66 patients (PVI: 22/ PVI+PWI: 22/ PVI+PWI+LAAEI: 22) (mean age 66.9 ± 11 years; male: 59.2%). The acute success rate was 100% in all three groups. The overall freedom from all-atrial arrhythmia recurrence at 12 months follow-up in patients who underwent PVI alone was 56% versus 75% in those who underwent PVI+PWI and 91% for the PVI+PWI+LAAEI group. No significant difference in complications among groups (p:0.09). No atrial esophageal fistula or embolic events occurred in any group during follow-up.
Conclusion: Our study suggests that PWI and LAAEI in addition to PVI appears to be the optimal ablation strategy to achieve the highest freedom from all-atrial arrhythmias in patients with non-paroxysmal AF without increasing risks of acute and long-term complications.