Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-140 - Long-term Outcome Of Tailored, Dispersion-guided Persistent Atrial Fibrillation Ablation (ID 1120)

Abstract

Background: Limited data is available on the long-term outcomes (>3 years) following tailored, dispersion-guided ablation are unknown.
Objective: We evaluated the long-term follow-up results after ablation of areas presenting with spatiotemporal dispersion, a visually recognizable electric footprint of AF drivers (Seitz et al. 2017).
Methods: We retrospectively enrolled 154 consecutive patients admitted for an index persistent AF ablation (28.6% of long-standing persistent AF). AF was sequentially mapped in both atria with a 20-pole PentaRay catheter. Regions harboring electrogram dispersion during AF were ablated while pulmonary vein isolation was only performed if dispersion regions overlapped with the pulmonary vein circumference. Follow-up consisted of either ECG or 24-hour Holter ECG at 3, 6, 9, 12 months and then yearly.
Results: The follow-up was obtained in 140/154 patients: average follow-up duration: 44 ± 13 months. The index procedure duration was 155 min (+/- 40 min). AF terminated in 125 patients (89%). After a single procedure, 36 patients (25%) remained free from any arrythmia and 67 (47%) free from AF. 46 patients (32,8%) relapsed in atrial tachycardia which was ablated successfully in most patients (93 %). After 1.9 +/- 0.9 procedures, 95 patients (67.8%) were free from any arrythmia. 15 patients (13%) were no longer in persistent AF but presented with paroxysmal AF.
Conclusion: We conducted a retrospective comparison of the long-term outcomes of dispersion ablation with the ones reported in historical series (Stepwise, Sequential approaches, Table). Our results suggest that dispersion ablation is associated with higher long-term effectiveness.
Sequential ablation (Tilz et al. JACC 2012)Stepwise ablation (Wynn et al Open Heart. 2016)Stepwise ablation (Scherr et al. CircEP 2015)Dispersion-guided ablation
Continuous AF episode (mo)49 +/-44NA13 (7-24)11 +/-12
Procedure time (hrs)NA3.34.25 +/- 1.152.5+/-0.66
AF TerminationNA21%80%88%
Follow-up (mo)56465844
Freedom from any arrythmia42%52%62%67.8%

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