loading page

Very Long-term Outcome after Linear vs. Electrogram-guided Ablation for Persistent Atrial Fibrillation: A Propensity Score-matched Analysis.
  • +13
  • Seigo Yamashita,
  • Michifumi Tokuda,
  • Saagar Mahida,
  • Hidenori Sato,
  • Hidetsugu Ikewaki,
  • Hirotsuna Oseto,
  • Masaaki Yokoyama,
  • Ryota Isogai,
  • Kenichi Tokutake,
  • Kenichi Yokoyama,
  • Ryohsuke Narui,
  • Mika Hioki,
  • Shin-ichi Tanigawa,
  • Ken-ichi Sugimoto,
  • Michihiro Yoshimura,
  • Teiichi Yamane
Seigo Yamashita
The Jikei University School of Medicine
Author Profile
Michifumi Tokuda
Brigham & Women's Hospital
Author Profile
Saagar Mahida
1. Hôpital Cardiologique du Haut-Lévêque
Author Profile
Hidenori Sato
The Jikei University School of Medicine
Author Profile
Hidetsugu Ikewaki
The Jikei University School of Medicine
Author Profile
Hirotsuna Oseto
The Jikei University School of Medicine
Author Profile
Masaaki Yokoyama
Jikei University School of Medicine
Author Profile
Ryota Isogai
The Jikei University School of Medicine
Author Profile
Kenichi Tokutake
The Jikei University School of Medicine
Author Profile
Kenichi Yokoyama
The jikei university school of medicine
Author Profile
Ryohsuke Narui
The Jikei University School of Medicine
Author Profile
Mika Hioki
The Jikei University School of Medicine
Author Profile
Shin-ichi Tanigawa
Brigham and Women's Hospital Biomedical Research Institute
Author Profile
Ken-ichi Sugimoto
Jikei University School of Medicine
Author Profile
Michihiro Yoshimura
Jikei University School of Medicine
Author Profile
Teiichi Yamane
Jikei University School of Medicine
Author Profile

Abstract

Background: The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. Methods: In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n=52) and one with PVI and EGM-guided ablation (EGM-group; n=52). Results: Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p=0.76). During 100±28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8±0.9 procedures) compared with EGM-group (Logrank test: P=0.0001 and P=0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of AAs recurrence. Conclusions: Linear ablation is a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.