SPC365

Catheter ablation of long-standing persistent atrial fibrillation: the ugly type of AF?

Session: CO 03 - Flutter/atrial fibrilation
Speaker: Joana Brito

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 04. Arrhythmias, General
Subtheme: 04.4 Arrhythmias, General – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Joana Brito; Tiago Rodrigues; Sara Pereira; Pedro Silverio Antonio; Beatriz Silva; Pedro Alves da Silva; Ceu Barreiros; Gustavo Lima da Silva; Luis Carpinteiro; Nuno Cortez-Dias; João de Sousa; Fausto j. Pinto

<p><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:&nbsp;</strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In atrial fibrillation (AF) patients (pts), catheter ablation (CA) by isolating pulmonary veins (PVI) is the most effective therapeutic option in order to maintain sinus rhythm. The success rate of CA relies on type and duration of AF, being more successful in pts with paroxysmal AF and presenting suboptimal success in pts with long-standing persistent AF (LSPAF, &gt;12 months).&nbsp;</span></span></span></p>

<p><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate the success of AF ablation, particularly in LSPAF.</span></span></span></p>

<p><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single-center prospective study of pts submitted to CA between 2004 and 2020. The strategy, regardless of the type of AF, was based on PVI, complemented by cavo-tricuspid isthmus line (CTI) in pts with history of flutter. Additional CA strategies were selectively considered in pts with stable atypical flutter conversion, persistent triggers or no electrograms in the VPs. Pts were monitored with Holter/7-day event loop recorder (3, 6, 12 months and annually up to 5 years). Success was defined after the 90th day ablation, according to the absence of recurrences of any sustained atrial arrhythmias (&gt; 30 sec). Cox regression and Kaplan-Meier survival were used to compare the success of ablation as a function of the clinical type of AF.</span></span></span></p>

<p><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:&nbsp;</strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">862 pts were submitted to AF ablation (67.3% male, mean age of 58&plusmn;0.41 years), including 130 pts (15.1%) with LSPAF, 63.3% with paroxysmal AF and 21.6% with short-duration persistent AF (SDPAF). In LSPAF, PVI was performed with irrigated catheter in 26.4%, PVAC in 39.5% and cryoablation in 34.1%. With a mean follow up period of 838 (IQ 159-1469) days, the 3-year success rate after a single procedure was 54.1% in LSPAF, compared to 72.4% in paroxysmal AF and 61.6% in SDPAF (LogRank - p&lt;0.0001 - figure 1). The risk of arrhythmic recurrence was 37% higher in patients with LSPAF comparing with other groups (HR 0.63 CI 95% 0.43-0.92, p 0.016).&nbsp;</span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">However after a mean of 1.17 procedures/patients, the success difference between groups was not detect (LogRank &ndash; p=0.112 &ndash; figure 2). With additional ablation procedures (REDO), the success rate at 3 years was 82.9% LSPAF pts, compared 88.2% in paroxysmal AF pts and 83.6% in SDPAF pts.&nbsp;&nbsp;</span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In LSPAF pts, different ablation techniques did not predict arrhythmic recurrence. Regarding comorbidities, higher prevalence of peripheral arterial disease (PAD, p=0.005) a higher NT-proBNP (p=0.006) and left auricular volume (p=0.045) were associated with arrhythmic relapse.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:&nbsp;</strong></span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">AF ablation is more effective when performed earlier in the natural history of the disease. However, even in LSPAF pts, an acceptable rate of success can be achieve with additional procedures, independently from the ablation techniques.&nbsp;</span></span></span></p>