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Active or Passive Pulmonary Vein in Atrial Fibrillation: Is Pulmonary Vein Isolation always essential?
MedLine Citation:
PMID:  24418165     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The role of pulmonary veins (PVs) in persistent atrial fibrillation (AF) perpetuation appears less important than in paroxysmal AF. Electrogram-based Substrate ablation is not widely performed as a stand-alone strategy OBJECTIVE: We sought to evaluate PV activity in AF perpetuation and efficacy of our patient-tailored ablation strategy (Electrogram-based Substrate ablation ± PV isolation [PVI]).
METHODS: One hundred and twenty one patients with paroxysmal (n=19), persistent (n=77) or long-standing persistent AF (n=25), underwent Electrogram-based Substrate ablation with AF termination endpoint: Sinus Rhythm (SR) or Atrial Tachycardia conversion. Before ablation, we classified PVs as "Passive" if silent PV or if PV cycle Length > left atrial appendage cycle Length. No PVI was performed in such cases.
RESULTS: Passive PVs were observed in 52/121 patients (paroxysmal = 0%, persistent =40%, long-standing persistent = 76 % [p<0.0001]). Substrate ablation terminated AF in 95.6% (SR conversion in 80.2%). Compared to patients with active PVs, patients with passive PVs had longer AF sustained duration (19.1 ± 29.7 vs 4.9 ± 11.1 months, p<0.0001), larger left atrial diameter (46.9 ± 7.3 vs 41.9 ± 6.0 mm, p=0.0014), lower left ventricular ejection fraction (45.4 ± 13.5 vs 55.1 ± 9.4 %, p<.0001) and more often structural heart disease (57% vs 33%, p=0.02). After a 20.39 ±11.23 month- FU (1.6 procedure /patient), 82 % were arrhythmia free with this strategy.
CONCLUSIONS: PVs activity during AF decreases with: AF chronicity, left atrial dilatation and left ventricular ejection fraction decrease. Our patient-tailored ablation strategy without systematic PVI provides good results.
Authors:
Julien Seitz; Jérôme Horvilleur; Laurence Curel; Jérôme Lacotte; Alexandre Maluski; Ange Ferracci; Michel Bremondy; Arnaud Rosier; Mehran Monchi; Guillaume Penaranda; Jacques Faure; Sylvain Beurtheret; André Pisapia
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-10
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014. Published by Elsevier Inc.
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