The Stepwise Radiofrequency Ablation of Idiopathic Persistent Atrial Fibrillation Helps to Reduce Arrhythmogenic Substrate

Aleksei Kovalev, Andrey Filatov, Olga Bockeria, Leo Bockeria

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–A

Abstract

Objectives. The evaluation of efficacy of stepwise approach in reduction of arrhytmogenic substrate of idiopathic persistent atrial fibrillation.

Methods: from 2013 to 2015 43 patients with persistent AF underwent stepwise ablation with analysis of complex fragmentation atrial activity during every step. First stage included antral isolation of pulmonary veins and right isthmus. Second stage included verification of pulmonary veins reconduction and additional lesion in left atrium (roof line, posterior wall, full “box lesion”). Also 60 patients with idiopathic persistent AF with traditional combined procedure (simultaneous PVI and endocardial “box lesion”) were included as control group. Mean follow-up was 2 years.

Results: Mean efficacy in study population after stepwise ablation and control group was 76,67% and 36,6% respectively, р<0,001. Pulmonary veins reconduction was found in 53,48% of patients in study population, and right isthmus reconduction in 4,65%. The analysis of fragmentation in first stage showed that the median number of significantly involved in arrhythmogenesis areas of LA was 6 (5;6) with median CFAE surface 22,95 cm² (19,3;24,8). In the second stage this parameters were 3 (3;4) and 12,55 cm² (10,6;12,9). No complications and mortality was observed.

Conclusion: stepwise approach can be useful in reduction of arrhytmogenic substrate and is characterized with above-average efficacy and lack of complications. Withal, electrophysiological verification of CFAE shows that mostly half of AF substrate areas are related to antrum of pulmonary veins and tend to reconduction in time.