The Study Of Ablation Strategy And Post-ablation Prognosis For The Treatment Of Non-Proxysmal Atrial Fibrillation

Part ?: Efficacy of Sole Pulmonary Vein Isolation in Patients with Non-Proxysmal Atrial Fibrillation without Significant Left Atrium Scar Background: The mechanisms that circumferential pulmonary vein isolation(CPVI)alone could achieve success in some of the patients with non-paroxysmal atrial fibrillation(NPAF)are not well studied.This study sought to assess the clinical outcome of only CPVI approach in NPAF patients without significant left atrium(LA)scar.Methods and Results: A total of 241 consecutive patients with NPAF undergoing an initial ablation procedure were studied.After CPVI,cavo-tricuspid isthmus ablation and direct current(DC)cardioversion,high-density atrial voltage mapping was performed during sinus rhythm.Transitional voltage zone(TZ)was defined as 0.4-1.3 mV,and low voltage zone(LVZ)as < 0.4 mV.No LVZs were identified in one hundred and one patients(41.9%),and only CPVI was performed.Among the patients without LVZs,single-procedure freedom from atrial fibrillation(AF)/atrial tachycardia was achieved in 73 patients(72%),while 28 patients(28%)had AF recurrence with mean follow-up of 19±14 months.In CPVI+ LVZm group,103(73.5%)patients had no AF/AT recurrence.Compared to LVZm group,patients were younger,higher FE value and smaller diastolic-end left ventricular diameter.Conclusions: The CPVI alone strategy for patients with NPAF can be performed in highly selective patients without LVZs.Sole CPVI can significant decrease macroreentrant atrial tachycardias after AF ablation,and clinical outcome is relative to other ablation strategies.Part II: Association between Transitional Zone Index and Atrial Fibrillation Recurrence in Patients after Pulmonary Vein Isolation Background: left atrial fibrosis is involved in the initiation and maintenance of non-paroxysmal atrial fibrillation.Substrate-guided ablation can significantly improve the outcome of atrial fibrillation after circumferential pulmonary vein isolation(CPVI).Transitional zone voltage was defined as 0.4-1.3m V,which represents the healthy extent of left atrium.The purpose of the study was to evaluate the association between transitional zone and atrial fibrillation recurrence after radiofrequency ablation.Methods and Results: totally 101 patients with non-paroxysmal atrial fibrillation without low voltage zone were included in the study undergoing only CPVI and cavo-tricuspid isthmus ablation.Transitional voltage zone was defined as 0.4-1.3m V.Among these patients,index procedure freedom from atrial fibrillation(AF)/atrial tachycardia was achieved in 73 patients(72%),while 28 patients had AF recurrence after mean follow-up of 29±14 months.In univariate analysis,transitional voltage zone(p=0.001,HR=1.77,95% CI= 1.13-1.35)independently predicted AF recurrence.Transitional voltage zone index(TVZi)> 0.19 was the best cut-off value for predicting AF occurrence by ROC curve analysis(AUC 0.733,sensitivity= 61%;specificity= 83%;positive predictive value= 44%;negative predictive value= 86%).Conclusions:TZ may present the healthy extent of left atrium,which has significant variation from people to people.TZi has trend towards the association with AF recurrence.