Efficacy of extended antrum ablation based on substrate mapping plus pulmonary vein isolation in the treatment of atrial fibrillation

Lin Chen; Jian-Quan Chen; Tian Zou; Qian Chen; Liang-Hua Lian; Zhi-Ping Yang; Mei-Qiong Wu; Ya-Zhou Lin; Yi-Ming Peng; Wei Lin; Xue-Wen Liao; Qi-Lei Huang; Jian-Cheng Zhang

doi:10.1016/j.repc.2021.02.014

Efficacy of extended antrum ablation based on substrate mapping plus pulmonary vein isolation in the treatment of atrial fibrillation

Rev Port Cardiol. 2022 Jan;41(1):17-26. doi: 10.1016/j.repc.2021.02.014. Epub 2021 Sep 22.

[Article in English, Portuguese]

Authors

Affiliations

¹ Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, PR China.
² Department of Critical Care Medicine Division Four, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, PR China.
³ Department of Cardiology, Nanping First Hospital Affiliated to Fujian Medical University, Nanping No. 1 Hospital, Nanping, PR China.
⁴ Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, PR China. Electronic address: fjzhangjiancheng@126.com.

PMID: 36062675
DOI: 10.1016/j.repc.2021.02.014

Abstract

Introduction and objectives: Pulmonary vein isolation (PVI) technique has become the cornerstone of atrial fibrillation (AF) catheter ablation. The objective of this study was to assess the efficacy and safety of extended antrum ablation based on electrophysiological substrate mapping plus PVI in AF patients who underwent cryoballoon ablation.

Methods: In this observational study, a total of 121 paroxysmal AF patients and 80 persistent AF patients who did not achieve the procedure endpoint after cryoballoon ablation received extra extended antrum ablation (EAA) based on electrophysiological substrate mapping via radiofrequency ablation (EAA group). As a control group (PVI group), among paroxysmal AF and persistent AF patients, we conducted a propensity score-matched cohort, in whom only PVI was completed.

Results: The average follow-up time was 15.27±7.34 months. Compared with PVI group, paroxysmal AF patients in the EAA group had a significantly higher rate of AF-free survival (90.1% vs. 80.2%, p=0.027) and AF, atrial flutter, or atrial tachycardia (AFLAT) -free rate survival (89.3% vs. 79.3%, p=0.031). Persistent AF patients in the EAA group also had a significantly higher rate of AF-free survival (90.0% vs. 75.0%, p=0.016) and AFLAT-free survival (88.8% vs. 75.0%, p=0.029) than PVI group. Complication rates did not significantly differ between both groups, in either paroxysmal AF or persistent AF patients.

Conclusion: Our findings demonstrate that extra extended antrum ablation based on electrophysiological substrate mapping is effective and safe. Moreover, the strategy can improve the outcome of AF cryoablation.

Keywords: Ablação antral alargada; Atrial fibrillation; Crioablação; Cryoballoon ablation; Extended antrum ablation; Fibrilhação auricular; Follow-up.