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Long term effectiveness of left sided AFl ablation
Session:
Posters (Sessão 2 - Écran 1) - Arritmias - miscelânea
Speaker:
Joana Brito
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.7 Arrhythmias, General – Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Joana Brito; Beatriz Valente Silva; Pedro Alves Silva; Afonso Nunes Ferreira; Gustavo Lima da Silva; Ana Bernardes; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>The technological advance in the electroanatomical mapping along with the enhanced experience in atrial flutter (AFl) ablation made room for a better comprehension of the circuits involved and led to more effective procedure. Long-term results of AFl ablation guided through high-density mapping are still unknown.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To evaluate the long-term success of left-sided AFl ablation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Single-center retrospective study of left-sided AFl patients (pts) submitted to a high-density mapping and ablation from 2015 to 2022 and with a minimum post-procedure follow-up of 6 months. The ablation strategy consisted in linear applications transecting the critical shared isthmus in pts with macro-reentrant circuits, and focal applications in the ones with micro/localized reentries. Acute success was defined as conversion to sinus rhythm with the planned ablation set. The procedure endpoint was the demonstration of conduction block in a remap during pacing close to the ablation line. Arrhythmic relapse was defined as atrial fibrillation or AFl recurrence. Kaplan-Meyer analysis was used to estimate the event-free survival during follow-up and Cox regression was used to identify the predictors of arrhythmic relapse.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>A total of<strong> </strong>82 pts were included (63% male, 67±12 years old), including 21% with ischemic and 12% with dilated cardiomyopathy. About 53% had been submitted to a prior pulmonary vein isolation, including a left atrial linear ablation in 17%. Acute success was achieved in 93%, persisting conduction through the ablation line in the remaining 6 pts. After a single procedure, the 1-year success rate was 75%, decreasing to 63% at 3-years. During a mean follow-up 3±2 years, 14 (17%) were submitted to a second procedure, consisting in typical AFl ablation in 2, PVI in 1, focal tachycardia ablation in 1 and atypical AFl redo in 8 pts. Among pts undergoing atypical AFl redo, a completely new circuit was recognized in 2, but the dominant mechanism was scar-related in relation to the previous ablation (N=4) or gap-related (N=4). After additional redo procedures, freedom from arrhythmia recurrence increased to 81% at 1 year and 68% at 3 years – figure 1. In 4 pts (5.5%) AV nodal ablation was performed due to persistent arrhythmia.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Arrhythmic relapse was significantly more common in older pts (72±8 vs 64±12, P=0.028). No other clinical or procedural characteristics were significantly associated with relapse.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Left sided AFL ablation, based on a systematic mapping approach aimed to clarify the arrhythmia mechanism and to validate the conduction block over the ablation line, is highly successful, allowing sinus rhythm restoration in the vast majority of pts.</span></span></p>
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