Background

The strategy for atrial fibrillation ablation in persistent atrial fibrillation remains controversial. A single-catheter approach was recently validated for pulmonary vein isolation.

Aim

To evaluate the feasibility of this approach to performing persistent atrial fibrillation ablation, including pulmonary vein isolation and atrial lines, if needed.

Methods

We prospectively included 159 consecutive patients referred to our centre for a first persistent atrial fibrillation ablation between January 2018 and December 2018. All patients underwent pulmonary vein isolation. If the patient was still in atrial fibrillation (spontaneously or inducible), we subsequently performed a stepwise approach, including roof line, anterior mitral line, posterior box lesion and cavotricuspid isthmus line. Finally, if patient remained in atrial fibrillation at the end of the procedure, a synchronized direct-current cardioversion was applied to restore sinus rhythm.

Results

At baseline, 54 patients were in sinus rhythm and underwent pulmonary vein isolation. For patients in atrial fibrillation, after pulmonary vein isolation and ablation of additional lines, if needed, 18 patients were converted to atrial tachycardia and one directly to sinus rhythm; 96 were still in atrial fibrillation and underwent direct-current cardioversion. After a mean follow-up of 17 ± 6 months, 57 patients (36%) experienced atrial arrhythmia recurrence. No deaths, tamponades or phrenic nerve injuries were observed following the procedure. The main mode of arrhythmia recurrence was atrial fibrillation in 75% of cases and atrial tachycardia in 25% of cases.

Conclusion

A single-catheter approach, including pulmonary vein isolation and atrial lines, is feasible and safe in patients undergoing persistent atrial fibrillation ablation, with an acceptable success rate of 64% at mid-term follow-up.

中文翻译：

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单导管简化的持续性房颤消融逐步方法：可行性研究

背景

持续性房颤的房颤消融策略仍存在争议。最近验证了单导管方法可用于肺静脉隔离。

目标

评估这种方法进行持续性心房颤动消融的可行性，包括肺静脉隔离和心房线，如果需要的话。

方法

我们前瞻性地纳入了 2018 年 1 月至 2018 年 12 月期间转诊至我们中心进行首次持续性房颤消融的 159 名连续患者。所有患者均接受了肺静脉隔离。如果患者仍处于房颤（自发性或诱发性），我们随后进行了逐步入路，包括房顶线、二尖瓣前线、后盒病变和三尖瓣峡部线。最后，如果患者在手术结束时仍处于心房颤动状态，则应用同步直流电复律以恢复窦性心律。

结果

在基线时，54 名患者处于窦性心律并接受了肺静脉隔离。对于房颤患者，经肺静脉隔离和附加线消融后，18例患者转为房性心动过速，1例直接转为窦性心律；96 人仍处于房颤状态并接受了直流电复律。平均随访 17  ±  6 个月后，57 名患者 (36%) 出现房性心律失常复发。手术后没有观察到死亡、填塞或膈神经损伤。心律失常复发的主要方式是75%的房颤和25%的房性心动过速。

结论

包括肺静脉隔离和心房导管在内的单导管方法对于接受持续性房颤消融的患者是可行和安全的，中期随访的成功率为 64%。