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Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: In persistent AF, outcomes after PVI alone is worse as the pathophysiology remains unclear. Prolonged AF duration is an independent predictor for worse success rates after catheter ablation. In this study, we investigated efficac...

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Autores principales: Bahlke, F, Erhard, N, Krafft, H, Englert, F, Popa, M, Telishevska, M, Lengauer, S, Risse, E, Lennerz, C, Reents, T, Bourier, F, Hessling, G, Deisenhofer, I
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206870/
http://dx.doi.org/10.1093/europace/euad122.138
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author Bahlke, F
Erhard, N
Krafft, H
Englert, F
Popa, M
Telishevska, M
Lengauer, S
Risse, E
Lennerz, C
Reents, T
Bourier, F
Hessling, G
Deisenhofer, I
author_facet Bahlke, F
Erhard, N
Krafft, H
Englert, F
Popa, M
Telishevska, M
Lengauer, S
Risse, E
Lennerz, C
Reents, T
Bourier, F
Hessling, G
Deisenhofer, I
author_sort Bahlke, F
collection PubMed
description FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: In persistent AF, outcomes after PVI alone is worse as the pathophysiology remains unclear. Prolonged AF duration is an independent predictor for worse success rates after catheter ablation. In this study, we investigated efficacy and safety of ablation of spatio-temporal dispersions, as additional ablation strategy after PVI in patients with long-standing persistent AF. METHODS: All consecutive patients with long-standing persistent AF treated with an AI-based algorithm for detection of spatio-temporal dispersion in our institution between 05/21 and 10/22 were included (n = 41, see table 1). The procedure was done using a high-density 3D-Map and an algorithm for detection of right and left atrial areas with spatio-temporal dispersion (DISPERS). Ablation of DISPERS was aiming at homogenizing, dissecting, isolating or connecting DISPERS areas to non-conducting structures. Follow-up contained regular visits at our out-patient-clinic and repetitive 7 day Holter ECGs. Late recurrence (LR) was defined as recurrence after 90 days or as recurrence, which caused further ablation. All complications requiring intervention or causing long-term sequelae were classified as major complications. RESULTS: In 24/41 pts (58.5%), the DISPERS guided ablation was the first AF ablation. Patients were suffering from very long-standing persistent AF with a mean AF duration of 64.89 ± 54.77 months. Additional to circumferential PVI, ablation of all detected left atrial (100%) and right atrial (68.3%) DISPERS areas was performed, leading to significant slowing of AF cycle length (mean 23.3%) or termination of AF to AT (5/41, 12.2%) or direct conversion to SR (6/41, 14.6%). One major complication occurred (1/41 (2.4%), pseudoaneurysm, resolving after manual compression). Three patients (7.3%) required temporary external pacing due to delayed sinus recovery after the procedure. No patient was in need of permanent pacemaker implantation. LR occurred in 25 patients (61.0 %): In 8/25 patients (32 %), LR was solely AF, whereas in 15/25 patients (60%) LR was a left AFlutt. In 2 patients (8%), AF and left AFlutt was detected. During a follow-up of 231 ± 129 days, 72.9 % of patients remained in sinus rhythm undergoing 1.6 ± 0.68 ablations (s. Figure 1; 4,9% of patients on AAD). Additionally, Figure 2 illustrates the AF-free outcome in all patients. CONCLUSION: Ablation of arrhythmogenic substrate identified by spatio-temporal dispersion yielded in this cohort of extensively long-standing persistent AF patients in high success rates regarding elimination of AF. Most arrhythmia recurrences were reentrant AT. After a total of 1.6 procedures, freedom from AF and AT was >72%. Despite prolonged procedure times, complication rates remained very low. Extending study population and follow-up is needed to evaluate long-term efficacy of dispersion-guided ablation. [Figure: see text] [Figure: see text]
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spelling pubmed-102068702023-05-25 Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions Bahlke, F Erhard, N Krafft, H Englert, F Popa, M Telishevska, M Lengauer, S Risse, E Lennerz, C Reents, T Bourier, F Hessling, G Deisenhofer, I Europace 10.4.5 - Rhythm Control, Catheter Ablation FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: In persistent AF, outcomes after PVI alone is worse as the pathophysiology remains unclear. Prolonged AF duration is an independent predictor for worse success rates after catheter ablation. In this study, we investigated efficacy and safety of ablation of spatio-temporal dispersions, as additional ablation strategy after PVI in patients with long-standing persistent AF. METHODS: All consecutive patients with long-standing persistent AF treated with an AI-based algorithm for detection of spatio-temporal dispersion in our institution between 05/21 and 10/22 were included (n = 41, see table 1). The procedure was done using a high-density 3D-Map and an algorithm for detection of right and left atrial areas with spatio-temporal dispersion (DISPERS). Ablation of DISPERS was aiming at homogenizing, dissecting, isolating or connecting DISPERS areas to non-conducting structures. Follow-up contained regular visits at our out-patient-clinic and repetitive 7 day Holter ECGs. Late recurrence (LR) was defined as recurrence after 90 days or as recurrence, which caused further ablation. All complications requiring intervention or causing long-term sequelae were classified as major complications. RESULTS: In 24/41 pts (58.5%), the DISPERS guided ablation was the first AF ablation. Patients were suffering from very long-standing persistent AF with a mean AF duration of 64.89 ± 54.77 months. Additional to circumferential PVI, ablation of all detected left atrial (100%) and right atrial (68.3%) DISPERS areas was performed, leading to significant slowing of AF cycle length (mean 23.3%) or termination of AF to AT (5/41, 12.2%) or direct conversion to SR (6/41, 14.6%). One major complication occurred (1/41 (2.4%), pseudoaneurysm, resolving after manual compression). Three patients (7.3%) required temporary external pacing due to delayed sinus recovery after the procedure. No patient was in need of permanent pacemaker implantation. LR occurred in 25 patients (61.0 %): In 8/25 patients (32 %), LR was solely AF, whereas in 15/25 patients (60%) LR was a left AFlutt. In 2 patients (8%), AF and left AFlutt was detected. During a follow-up of 231 ± 129 days, 72.9 % of patients remained in sinus rhythm undergoing 1.6 ± 0.68 ablations (s. Figure 1; 4,9% of patients on AAD). Additionally, Figure 2 illustrates the AF-free outcome in all patients. CONCLUSION: Ablation of arrhythmogenic substrate identified by spatio-temporal dispersion yielded in this cohort of extensively long-standing persistent AF patients in high success rates regarding elimination of AF. Most arrhythmia recurrences were reentrant AT. After a total of 1.6 procedures, freedom from AF and AT was >72%. Despite prolonged procedure times, complication rates remained very low. Extending study population and follow-up is needed to evaluate long-term efficacy of dispersion-guided ablation. [Figure: see text] [Figure: see text] Oxford University Press 2023-05-24 /pmc/articles/PMC10206870/ http://dx.doi.org/10.1093/europace/euad122.138 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle 10.4.5 - Rhythm Control, Catheter Ablation
Bahlke, F
Erhard, N
Krafft, H
Englert, F
Popa, M
Telishevska, M
Lengauer, S
Risse, E
Lennerz, C
Reents, T
Bourier, F
Hessling, G
Deisenhofer, I
Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions
title Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions
title_full Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions
title_fullStr Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions
title_full_unstemmed Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions
title_short Targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions
title_sort targeted ablation of arrhythmogenic substrate in complex cases of very long-standing persistent atrial fibrillation: successful ablation of spatio-temporal dispersions
topic 10.4.5 - Rhythm Control, Catheter Ablation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206870/
http://dx.doi.org/10.1093/europace/euad122.138
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