Heart rhythm disorders and pacemakers: Pulmonary vein isolation combined with substrate modification for persistent atrial fibrillation treatment in patients with valvular heart diseases

X Wang, X Liu, H Shi, J Gu, Y Sun, L Zhou, W Hu
Heart 2009, 95 (21): 1773-83

AIMS: To compare the efficacy and safety of pulmonary vein (PV) isolation combined with substrate modification for persistent atrial fibrillation (AF) treatment in patients with and without valvular heart disease (VHD).

METHODS AND RESULTS: 111 patients with persistent AF were enrolled for catheter ablation: 51 with valvular heart disease (group I) and 60 without valve defect as controls (group II). Circumferential pulmonary vein isolation (CPVI) and complex fractionated atrial electrogram (CFAE) ablation were performed guided by the CARTO system. The end point was PV isolation and CFAE elimination, which was achieved in almost all patients. There was no significant difference in total procedure time, proportion of PV isolation between two groups. The proportion of AF termination was comparable between the two groups by CPVI, but was higher in group II than in group I by CFAE ablation. The fluoroscopic time was significantly longer in group I than in group II. Temporal catheter entrapment occurred in one patient in group I; one patient in group II developed major stroke. Atrial tachyarrhythmias recurred in 25 (49%) patients of group I and in 27 (45%) of group II at a mean (SD) 4 (2) months of follow-up (p = 0.67). Re-ablation was performed in 16 patients of group I and 18 of group II (p = 0.89). At 12 months' follow-up, 34 (66.7%) patients in group I and 43 (71.7%) in group II had no recurrence of atrial tachyarrhythmias (p = 0.56).

CONCLUSION: CPVI combined with CFAE ablation was safe and efficacious for persistent AF treatment in patients with VHD. The outcome was comparable with that in patients without VHD. More x-ray exposure was needed to avoid valve prosthesis impairment.

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