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Multiple Procedure Outcomes for Non-Paroxysmal Atrial Fibrillation: Left Atrial Posterior Wall Isolation versus Stepwise Ablation
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  • Chirag Barbhaiya,
  • Robert Knotts,
  • Nicholas Beccarino,
  • Alvaro Vargas-Pelaez,
  • Lior Jankelson,
  • Scott Bernstein,
  • David Park,
  • Douglas Holmes,
  • Anthony Aizer,
  • Larry Chinitz
Chirag Barbhaiya
New York University Langone Health
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Robert Knotts
New York University Langone Health
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Nicholas Beccarino
New York University Langone Health
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Alvaro Vargas-Pelaez
New York University Langone Health
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Lior Jankelson
New York University Langone Health
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Scott Bernstein
New York University Langone Health
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David Park
New York University Langone Health
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Douglas Holmes
New York University Langone Health
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Anthony Aizer
New York University Langone Health
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Larry Chinitz
New York University School of Medicine
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Abstract

Objective: To compare multiple-procedure catheter ablation outcomes of a stepwise approach versus left atrial posterior wall isolation (LA PWI) in patients undergoing non-paroxysmal atrial fibrillation (NPAF) ablation. Background: Unfavorable outcomes for stepwise ablation of NPAF in large clinical trials may be attributable to pro-arrhythmic effects of incomplete ablation lines. It is unknown if a more extensive initial ablation strategy results in improved outcomes following multiple ablation procedures. Methods: 222 consecutive patients with NPAF underwent first-time ablation using a contact-force sensing ablation catheter utilizing either a stepwise (Group 1, n=111) or LA PWI (Group 2, n=111) approach. The duration of follow-up was 36 months. The primary endpoint was freedom from atrial arrhythmia >30s. Secondary endpoints were freedom from persistent arrhythmia, repeat ablation, and recurrent arrhythmia after repeat ablation. Results: There was similar freedom from atrial arrhythmias after index ablation for both stepwise and LA PWI groups at 36 months (60% vs. 69%, p=0.1). The stepwise group was more likely to present with persistent recurrent arrhythmia (29% vs 14%, p=0.005) and more likely to undergo second catheter ablation (32% vs. 12%, p<0.001) compared to LA PWI patients. Recurrent arrhythmia after repeat ablation was more likely in the stepwise group compared to the LA PWI group (15% vs 4%, p=0.003). Conclusions: Compared to a stepwise approach, LA PWI for patients with NPAF resulted in a similar incidence of any atrial arrhythmia, lower incidence of persistent arrhythmia, and fewer repeat ablations. Results for repeat ablation were not improved with a more extensive initial approach.

Peer review status:UNDER REVIEW

16 Jul 2020Submitted to Journal of Cardiovascular Electrophysiology
16 Jul 2020Submission Checks Completed
16 Jul 2020Assigned to Editor
18 Jul 2020Reviewer(s) Assigned
02 Aug 2020Review(s) Completed, Editorial Evaluation Pending
04 Aug 2020Editorial Decision: Revise Minor
15 Sep 20201st Revision Received
16 Sep 2020Submission Checks Completed
16 Sep 2020Assigned to Editor
16 Sep 2020Reviewer(s) Assigned
21 Sep 2020Review(s) Completed, Editorial Evaluation Pending