Trends and outcome of catheter ablation of atrial fibrillation over 9 years: Focus on empirical extra-pulmonary vein ablation

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Abstract

Background: The Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II (STAR-AF2) emphasized the importance of circumferential pulmonary vein isolation (CPVI) during AF ablation. Methods and Results: This study involved 2,297 consecutive patients (mean age, 58±11 years; 73.1% male, 70.1% paroxysmal AF) undergoing AF ablation from 2009 to 2017. We investigated the ablation lesion set, ablation time, catheter type, and clinical outcomes. Over the 9 years, the extra-pulmonary vein (PV) left atrial (LA) ablation rate (76.8% to 19.4%, P<0.001 for trend) and ablation time (P<0.001 for trend) decreased dramatically, whereas the 1-year recurrence rates decreased (21.8% to 14.1%, P=0.04 for trend). In persistent AF patients, the extra-PV LA ablation rate (91.4% to 55.3%, P<0.001) and ablation time (P<0.001) decreased after the STAR-AF2 report, but the 1-year recurrence rates remained similar (22.1% to 17.9%, P=0.281). A mesh-type flexible tip (MFT) catheter with a moderately increased radiofrequency power was used since 2012, and the MFT catheter was independently associated with a lower clinical recurrence compared to other irrigated-tip catheters (HR, 0.670; 95% CI: 0.559-0.803, P<0.001; log rank P=0.002) without increasing the procedure-related complications (OR, 1.434; 95% CI: 0.937-2.194, P=0.097). Conclusions: Over the 9 years the extra-PV LA ablation and 1-year recurrence rates in the AF ablation cohort decreased, in part due to improved catheter technology.

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Park, J. W., Yu, H. T., Kim, T. H., Uhm, J. S., Kim, J. Y., Joung, B., … Pak, H. N. (2019). Trends and outcome of catheter ablation of atrial fibrillation over 9 years: Focus on empirical extra-pulmonary vein ablation. Circulation Journal, 83(2), 304–312. https://doi.org/10.1253/circj.CJ-18-0928

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