Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-148 - Electrophysiologically Guided Pulmonary Vein Isolation In Patients With Long-lasting Persistent Atrial Fibrillation Using PRISM Index (ID 113)


Background: The optimal method for a pulmonary vein approach to long-standing persistent AF (LSPAF) is yet to be defined.
Objective: This study aimed to demonstrate that a modified wide circumferential PVI according to the PRISM index [PeRIodicity and SiMilarity] could guide the isolation of potential AF drivers within PVs or the vicinity of PVs.
Methods: Thirty pts (Group 1) with LSPAF were recruited and underwent a wide PVI (Carto V6 UDM version) using Smart touch with the ablation index. Regional AF electrograms were assessed by the PRISM index by Pentaray). If high PRISM areas were identified around the PVs or antra (1-2 cm from the ostia), a PVI encircling high PRISM areas was performed without additional substrate ablation. The clinical outcome was compared to age- sex- propensity score matched LSPAF patients and a traditional approach (PVI plus substrate ablation: Group 2, N=131).
Results: Before ablation, a total of 103 high PRISM regions were identified (average area 3.2±2.26 cm2, with 70% located in the PV/antra regions, PRISM: 468±216 ms, averaged consecutive rotations 2±0.9, range 0-8). The PRISM area in the PV antra region correlated with the number of ablation lesions (r=0.779, P<0.001). The procedural termination rate was higher (20% vs. 5%, P=0.04), there were fewer ablation lesions (97±31 vs.137±45, P=0.03), and the procedural time was shorter (P=0.03) in Group 1 than Group 2. During a follow up of 9±4 months, 23 (76.7%) Group 1 pts were free from any AF episodes (76.7% vs. 63.4 % in control group, Log-Rank P=0.126).
Conclusion: In LSPAF pts with a very wide antral PV isolation guided by PRISM without substrate modification produced a potential favorable clinical outcome.