A Simple Ablation Strategy Targeting Exclusively AF Triggers is Equally Effective for Paroxysmal and Persistent Atrial Fibrillation: Single Center Large Series

Backgrounds: Recent studies reported that the ablation strategies including ganglionated plexi ablation, linear ablation and ablation of complex and fractionated electrograms and atrial fibrillation (AF) rotors in conjunction with pulmonary vein isolation (PVI) were superior to the conventional ablation strategy aimed to eliminate AF triggers in terms of post-ablation clinical outcomes. It is controversial whether addition of above-mentioned supplementary ablation to PVI improves post-ablation clinical outcomes in persistent AF (PeAF). Purposes: To test the post-ablation clinical outcomes of our ablation strategy exclusively targeting AF triggers in paroxysmal (PAF) and PeAF, and to compare the post-ablation clinical outcomes between PAF and PeAF in a single center large series. Methods: Consecutive 1183 patients (pts) (age: 64±11 years, LA diameter: 40±6mm) with PAF (988 pts (84%)) or PeAF (195 pts (16%), AF duration: 5±3 months (range: 1-11)) who received ablation procedures in our institution were included. Irrespective of AF types, the procedure consisted of encircling PVI (EPVI) and SVC isolation (SVCI) in all pts, and additional ablation targeting non-PV, non-SVC AF triggers if spontaneous AF initiation was observed by high dose (100-400μg/hr) isoproterenol (ISP) infusion and bolus administration of 40mg of adenosine triphosphate (ATP) during ISP infusion. Procedure end point was complete elimination of spontaneous AF initiation on by ISP infusion and ATP boluses. Results: Total of 1949 procedures were performed in all 1183 pts (1.3±0.5/pt, range: 1-4). EPVI and SVCI were successful in all pts. Non-PV, non-SVC AF triggers were identified in 50 pts (4%) and eliminated by focal ablation in 42 (84%). Kaplan-Meier analysis revealed similarly favorable recurrence-free survivals after the last ablation procedure without antiarrhythmic drugs (blanking period of 1 month) in both PAF and PeAF groups (945 (96%)/988 vs. 190 (97%)/195; p>0.05, follow-up period: 414±245 days (median: 395)). Conclusions: This study exhibited that post-ablation recurrence-free survivals were similar between PAF and PeAF, even if only AF triggers were targeted. An ablation strategy targeting only AF triggers may be sufficient in both PAF and PeAF.