Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: Comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation

Sanghamitra Mohanty, Prasant Mohanty, Luigi Di Biase, Chintan Trivedi, Eli Hamilton Morris, Carola Gianni, Pasquale Santangeli, Rong Bai, Javier E. Sanchez, Patrick Hranitzky, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney P. Horton, Richard Hongo, Salwa Beheiry, Claude S. Elayi, Dhanunjaya Lakkireddy, Yaruva Madhu Reddy, Juan Viles Gonzalez, J. David BurkhardtAndrea Natale

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Left atrial (LF) tissue fibrosis is a hallmark of arrhythmogenic structural remodelling of the cardiac substrate in atrial fibrillation (AF).1 By providing the substrate needed for the persistence of AF, it is believed to impact the success of catheter ablation, one of the most effective rhythm control strategies in AF.1,2 Atrial fibrosis can be a pathological endpoint in several settings such as advanced age, genetic predisposition, myocardial ischemia, mitral valve disease, and mechanical overload of the heart.3,4 Interestingly, studies have shown similar degree of fibrosis in patients with and without history of AF.5 Therefore, the causal association between LA scar and AF occurrence and persistence still remains to be defined. After the seminal study by Haissaguerre et al. demonstrating pulmonary vein (PV) triggers initiating AF, PV isolation (PVI), and later PV antrum isolation (PVAI) have been widely performed in paroxysmal AF (PAF) patients with high success rate.6 However, based on results from multiple studies it is clear that PV triggers are not the only mechanism responsible for AF; PAF can be initiated by non-PV ectopic beats.7-9 Therefore, the clinical relevance of these non-PV drivers in influencing ablation-outcome cannot be undermined. Although PAF patients present with severe LA scar from time to time, very little data are available to guide in deciding for the best ablation strategy in this unique subset of AF population. Therefore, we aimed to compare the long-term outcome of three ablation approaches, namely PVAI only and PVAI combined with either scar homogenization or non-PV triggers ablation, in PAF patients with extensive LA scar.

Original languageEnglish (US)
Pages (from-to)1790-1797
Number of pages8
JournalEuropace
Volume19
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Pulmonary Veins
Atrial Fibrillation
Cicatrix
Veins
Fibrosis
Catheter Ablation
Genetic Predisposition to Disease
Mitral Valve
Myocardial Ischemia
Population

Keywords

  • Left atrial scar
  • Non-pulmonary vein triggers
  • Paroxysmal atrial fibrillation
  • Pulmonary vein antrum isolation
  • Scar homogenization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring : Comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation. / Mohanty, Sanghamitra; Mohanty, Prasant; Di Biase, Luigi; Trivedi, Chintan; Morris, Eli Hamilton; Gianni, Carola; Santangeli, Pasquale; Bai, Rong; Sanchez, Javier E.; Hranitzky, Patrick; Gallinghouse, G. Joseph; Al-Ahmad, Amin; Horton, Rodney P.; Hongo, Richard; Beheiry, Salwa; Elayi, Claude S.; Lakkireddy, Dhanunjaya; Madhu Reddy, Yaruva; Viles Gonzalez, Juan; Burkhardt, J. David; Natale, Andrea.

In: Europace, Vol. 19, No. 11, 01.11.2017, p. 1790-1797.

Research output: Contribution to journalArticle

Mohanty, S, Mohanty, P, Di Biase, L, Trivedi, C, Morris, EH, Gianni, C, Santangeli, P, Bai, R, Sanchez, JE, Hranitzky, P, Gallinghouse, GJ, Al-Ahmad, A, Horton, RP, Hongo, R, Beheiry, S, Elayi, CS, Lakkireddy, D, Madhu Reddy, Y, Viles Gonzalez, J, Burkhardt, JD & Natale, A 2017, 'Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: Comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation', Europace, vol. 19, no. 11, pp. 1790-1797. https://doi.org/10.1093/europace/euw338
Mohanty, Sanghamitra ; Mohanty, Prasant ; Di Biase, Luigi ; Trivedi, Chintan ; Morris, Eli Hamilton ; Gianni, Carola ; Santangeli, Pasquale ; Bai, Rong ; Sanchez, Javier E. ; Hranitzky, Patrick ; Gallinghouse, G. Joseph ; Al-Ahmad, Amin ; Horton, Rodney P. ; Hongo, Richard ; Beheiry, Salwa ; Elayi, Claude S. ; Lakkireddy, Dhanunjaya ; Madhu Reddy, Yaruva ; Viles Gonzalez, Juan ; Burkhardt, J. David ; Natale, Andrea. / Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring : Comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation. In: Europace. 2017 ; Vol. 19, No. 11. pp. 1790-1797.
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T2 - Comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation

AU - Mohanty, Sanghamitra

AU - Mohanty, Prasant

AU - Di Biase, Luigi

AU - Trivedi, Chintan

AU - Morris, Eli Hamilton

AU - Gianni, Carola

AU - Santangeli, Pasquale

AU - Bai, Rong

AU - Sanchez, Javier E.

AU - Hranitzky, Patrick

AU - Gallinghouse, G. Joseph

AU - Al-Ahmad, Amin

AU - Horton, Rodney P.

AU - Hongo, Richard

AU - Beheiry, Salwa

AU - Elayi, Claude S.

AU - Lakkireddy, Dhanunjaya

AU - Madhu Reddy, Yaruva

AU - Viles Gonzalez, Juan

AU - Burkhardt, J. David

AU - Natale, Andrea

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N2 - Left atrial (LF) tissue fibrosis is a hallmark of arrhythmogenic structural remodelling of the cardiac substrate in atrial fibrillation (AF).1 By providing the substrate needed for the persistence of AF, it is believed to impact the success of catheter ablation, one of the most effective rhythm control strategies in AF.1,2 Atrial fibrosis can be a pathological endpoint in several settings such as advanced age, genetic predisposition, myocardial ischemia, mitral valve disease, and mechanical overload of the heart.3,4 Interestingly, studies have shown similar degree of fibrosis in patients with and without history of AF.5 Therefore, the causal association between LA scar and AF occurrence and persistence still remains to be defined. After the seminal study by Haissaguerre et al. demonstrating pulmonary vein (PV) triggers initiating AF, PV isolation (PVI), and later PV antrum isolation (PVAI) have been widely performed in paroxysmal AF (PAF) patients with high success rate.6 However, based on results from multiple studies it is clear that PV triggers are not the only mechanism responsible for AF; PAF can be initiated by non-PV ectopic beats.7-9 Therefore, the clinical relevance of these non-PV drivers in influencing ablation-outcome cannot be undermined. Although PAF patients present with severe LA scar from time to time, very little data are available to guide in deciding for the best ablation strategy in this unique subset of AF population. Therefore, we aimed to compare the long-term outcome of three ablation approaches, namely PVAI only and PVAI combined with either scar homogenization or non-PV triggers ablation, in PAF patients with extensive LA scar.

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