Scholarlink

<p>The optimal ablation strategy beyond pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) remains unclear. This study evaluated the outcomes of PVI optimized using complex fractionated atrial electrograms (CFAE) and high-frequency mapping in patients with persistent AF. From March 2022 to December 2023, 55 patients undergoing first-time AF ablation were enrolled. Group 1 included 32 patients with paroxysmal AF, and Group 2 included 23 with persistent or long-standing persistent AF. All patients underwent PVI; in Group 2, additional ablation was guided by CFAE and high-frequency mapping when sinus rhythm was not restored or if inducible atrial tachyarrhythmias were present. Group 2 had higher rates of prior stroke (26.1% vs. 6.3%; <i>p</i> = 0.040) and heart failure (47.8% vs. 18.8%; <i>p</i> = 0.037). Although CHA₂DS₂-VASc scores were similar, Group 2 showed larger left atrial (LA) dimensions (46.4 vs. 36.6&#xa0;mm; <i>p</i> &lt; 0.001), greater LA volumes (192.4 vs. 113.4 mL; <i>p</i> &lt; 0.001), and lower ejection fractions (59.5% vs. 66.3%; <i>p</i> = 0.047). Linear ablation was more frequently required in Group 2. Early recurrence was higher (34.8% vs. 12.5%; <i>p</i> = 0.048), with a trend towards more late recurrence (21.7% vs. 6.3%; <i>p</i> = 0.089). Anti-arrhythmic discontinuation rates were similar. LA volume was the only independent predictor of late recurrence. A mapping-guided PVI optimization strategy incorporating CFAE and peak-frequency information was associated with favorable procedural outcomes in patients with persistent AF. These findings are hypothesis-generating and warrant further validation in controlled studies comparing this approach with PVI alone in persistent AF.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Clinical outcomes of pulmonary vein isolation with mapping-guided optimization in persistent atrial fibrillation

  • 期刊论文

  • 发表日期：

    2026年2月16日

查看全文
  • Wei-Chieh Lee,
  • Huang-Chung Chen,
  • Hsiu-Yu Fang,
  • Yung-Lung Chen,
  • Chih-Hsien Lin,
  • Pei-Chieh Huang,
  • Mien-Cheng Chen

摘要

The optimal ablation strategy beyond pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) remains unclear. This study evaluated the outcomes of PVI optimized using complex fractionated atrial electrograms (CFAE) and high-frequency mapping in patients with persistent AF. From March 2022 to December 2023, 55 patients undergoing first-time AF ablation were enrolled. Group 1 included 32 patients with paroxysmal AF, and Group 2 included 23 with persistent or long-standing persistent AF. All patients underwent PVI; in Group 2, additional ablation was guided by CFAE and high-frequency mapping when sinus rhythm was not restored or if inducible atrial tachyarrhythmias were present. Group 2 had higher rates of prior stroke (26.1% vs. 6.3%; p = 0.040) and heart failure (47.8% vs. 18.8%; p = 0.037). Although CHA₂DS₂-VASc scores were similar, Group 2 showed larger left atrial (LA) dimensions (46.4 vs. 36.6 mm; p < 0.001), greater LA volumes (192.4 vs. 113.4 mL; p < 0.001), and lower ejection fractions (59.5% vs. 66.3%; p = 0.047). Linear ablation was more frequently required in Group 2. Early recurrence was higher (34.8% vs. 12.5%; p = 0.048), with a trend towards more late recurrence (21.7% vs. 6.3%; p = 0.089). Anti-arrhythmic discontinuation rates were similar. LA volume was the only independent predictor of late recurrence. A mapping-guided PVI optimization strategy incorporating CFAE and peak-frequency information was associated with favorable procedural outcomes in patients with persistent AF. These findings are hypothesis-generating and warrant further validation in controlled studies comparing this approach with PVI alone in persistent AF.