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Very Long-term Outcome after Linear vs. Electrogram-guided Ablation for Persistent Atrial Fibrillation: A Propensity Score-matched Analysis.
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  • 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

Corresponding Author:seigoy722@yahoo.co.jp

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Michifumi Tokuda
Brigham & Women's Hospital
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Saagar Mahida
1. Hôpital Cardiologique du Haut-Lévêque
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Hidenori Sato
The Jikei University School of Medicine
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Hidetsugu Ikewaki
The Jikei University School of Medicine
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Hirotsuna Oseto
The Jikei University School of Medicine
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Masaaki Yokoyama
Jikei University School of Medicine
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Ryota Isogai
The Jikei University School of Medicine
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Kenichi Tokutake
The Jikei University School of Medicine
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Kenichi Yokoyama
The jikei university school of medicine
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Ryohsuke Narui
The Jikei University School of Medicine
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Mika Hioki
The Jikei University School of Medicine
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Shin-ichi Tanigawa
Brigham and Women's Hospital Biomedical Research Institute
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Ken-ichi Sugimoto
Jikei University School of Medicine
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Michihiro Yoshimura
Jikei University School of Medicine
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Teiichi Yamane
Jikei University School of Medicine
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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.