Atrial electroanatomical remodeling as a determinant of different outcomes between two current ablation strategies: Circumferential pulmonary vein isolation vs pulmonary vein isolation

Hye Jin Hwang, Jung Myung Lee, Boyoung Joung, Byung Ho Lee, Jin Bae Kim, Moon Hyoung Lee, Yangsoo Jang, Sung Soon Kim

Research output: Contribution to journalArticle

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Abstract

Background: The purpose of this study was to investigate the relationship between the efficacy of the 2 different ablation techniques of atrial fibrillation (AF) and left atrial (LA) size. Methods and Results: A total of 81 patients with paroxysmal AF (n = 58) or persistent AF (n = 23) refractory to antiarrhythmic drugs underwent circumferential pulmonary vein isolation (PVI; n = 45) or PVI (n = 36) without respect to echocardiographic results for LA volume index (LAVI).Of the 81 patients,41 had less dilated LA (group 1; LAVI <27 cc/m2) and 40 had dilated LA (group 2; LAVI≥27 cc/m2). During the 9-month follow-up, 33 patients (73.3%) after circumferential PVI and 18 (50%) after PVI (P = .031) were free of arrhythmia. The risk of recurrence was associated with persistent AF, hypertension, LAVI>27 ml/m2, PVI, early recurrence of AF, and lower left ventricular (LV) ejection fraction (all P value <.05). In the univariate analysis of each group, PVI (hazard ratio [HR]: 2.92, 95% confidence interval [CI]: 0.12-7.08, P = .018) was associated with late recurrence only in group 2. Cox regression analysis also showed that PVI (HR: 5.6, 95% CI: 1.9-16.56, P = .002) was a significant independent predictor of recurrence only in group 2. Conclusions: Circumferential PVI is more effective than PVI only in patients with a structural change of the atria, that is, a dilated LA. Our study suggests that a successful outcome in dilated LA may depend on wide modification of LA electroanatomical substrates, but wide ablation in less dilated LA may be unnecessary. Different technical strategies according to LA size are required for more a effective outcome.

Original languageEnglish
Pages (from-to)E69-E74
JournalClinical Cardiology
Volume33
Issue number3
DOIs
Publication statusPublished - 2010 Mar 1

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Atrial Remodeling
Pulmonary Veins
Atrial Fibrillation
Recurrence
Ablation Techniques
Confidence Intervals
Anti-Arrhythmia Agents
Stroke Volume
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{55f75b32e5a44462a0768fef7eed6ada,
title = "Atrial electroanatomical remodeling as a determinant of different outcomes between two current ablation strategies: Circumferential pulmonary vein isolation vs pulmonary vein isolation",
abstract = "Background: The purpose of this study was to investigate the relationship between the efficacy of the 2 different ablation techniques of atrial fibrillation (AF) and left atrial (LA) size. Methods and Results: A total of 81 patients with paroxysmal AF (n = 58) or persistent AF (n = 23) refractory to antiarrhythmic drugs underwent circumferential pulmonary vein isolation (PVI; n = 45) or PVI (n = 36) without respect to echocardiographic results for LA volume index (LAVI).Of the 81 patients,41 had less dilated LA (group 1; LAVI <27 cc/m2) and 40 had dilated LA (group 2; LAVI≥27 cc/m2). During the 9-month follow-up, 33 patients (73.3{\%}) after circumferential PVI and 18 (50{\%}) after PVI (P = .031) were free of arrhythmia. The risk of recurrence was associated with persistent AF, hypertension, LAVI>27 ml/m2, PVI, early recurrence of AF, and lower left ventricular (LV) ejection fraction (all P value <.05). In the univariate analysis of each group, PVI (hazard ratio [HR]: 2.92, 95{\%} confidence interval [CI]: 0.12-7.08, P = .018) was associated with late recurrence only in group 2. Cox regression analysis also showed that PVI (HR: 5.6, 95{\%} CI: 1.9-16.56, P = .002) was a significant independent predictor of recurrence only in group 2. Conclusions: Circumferential PVI is more effective than PVI only in patients with a structural change of the atria, that is, a dilated LA. Our study suggests that a successful outcome in dilated LA may depend on wide modification of LA electroanatomical substrates, but wide ablation in less dilated LA may be unnecessary. Different technical strategies according to LA size are required for more a effective outcome.",
author = "Hwang, {Hye Jin} and Lee, {Jung Myung} and Boyoung Joung and Lee, {Byung Ho} and Kim, {Jin Bae} and Lee, {Moon Hyoung} and Yangsoo Jang and Kim, {Sung Soon}",
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Atrial electroanatomical remodeling as a determinant of different outcomes between two current ablation strategies : Circumferential pulmonary vein isolation vs pulmonary vein isolation. / Hwang, Hye Jin; Lee, Jung Myung; Joung, Boyoung; Lee, Byung Ho; Kim, Jin Bae; Lee, Moon Hyoung; Jang, Yangsoo; Kim, Sung Soon.

In: Clinical Cardiology, Vol. 33, No. 3, 01.03.2010, p. E69-E74.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Atrial electroanatomical remodeling as a determinant of different outcomes between two current ablation strategies

T2 - Circumferential pulmonary vein isolation vs pulmonary vein isolation

AU - Hwang, Hye Jin

AU - Lee, Jung Myung

AU - Joung, Boyoung

AU - Lee, Byung Ho

AU - Kim, Jin Bae

AU - Lee, Moon Hyoung

AU - Jang, Yangsoo

AU - Kim, Sung Soon

PY - 2010/3/1

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N2 - Background: The purpose of this study was to investigate the relationship between the efficacy of the 2 different ablation techniques of atrial fibrillation (AF) and left atrial (LA) size. Methods and Results: A total of 81 patients with paroxysmal AF (n = 58) or persistent AF (n = 23) refractory to antiarrhythmic drugs underwent circumferential pulmonary vein isolation (PVI; n = 45) or PVI (n = 36) without respect to echocardiographic results for LA volume index (LAVI).Of the 81 patients,41 had less dilated LA (group 1; LAVI <27 cc/m2) and 40 had dilated LA (group 2; LAVI≥27 cc/m2). During the 9-month follow-up, 33 patients (73.3%) after circumferential PVI and 18 (50%) after PVI (P = .031) were free of arrhythmia. The risk of recurrence was associated with persistent AF, hypertension, LAVI>27 ml/m2, PVI, early recurrence of AF, and lower left ventricular (LV) ejection fraction (all P value <.05). In the univariate analysis of each group, PVI (hazard ratio [HR]: 2.92, 95% confidence interval [CI]: 0.12-7.08, P = .018) was associated with late recurrence only in group 2. Cox regression analysis also showed that PVI (HR: 5.6, 95% CI: 1.9-16.56, P = .002) was a significant independent predictor of recurrence only in group 2. Conclusions: Circumferential PVI is more effective than PVI only in patients with a structural change of the atria, that is, a dilated LA. Our study suggests that a successful outcome in dilated LA may depend on wide modification of LA electroanatomical substrates, but wide ablation in less dilated LA may be unnecessary. Different technical strategies according to LA size are required for more a effective outcome.

AB - Background: The purpose of this study was to investigate the relationship between the efficacy of the 2 different ablation techniques of atrial fibrillation (AF) and left atrial (LA) size. Methods and Results: A total of 81 patients with paroxysmal AF (n = 58) or persistent AF (n = 23) refractory to antiarrhythmic drugs underwent circumferential pulmonary vein isolation (PVI; n = 45) or PVI (n = 36) without respect to echocardiographic results for LA volume index (LAVI).Of the 81 patients,41 had less dilated LA (group 1; LAVI <27 cc/m2) and 40 had dilated LA (group 2; LAVI≥27 cc/m2). During the 9-month follow-up, 33 patients (73.3%) after circumferential PVI and 18 (50%) after PVI (P = .031) were free of arrhythmia. The risk of recurrence was associated with persistent AF, hypertension, LAVI>27 ml/m2, PVI, early recurrence of AF, and lower left ventricular (LV) ejection fraction (all P value <.05). In the univariate analysis of each group, PVI (hazard ratio [HR]: 2.92, 95% confidence interval [CI]: 0.12-7.08, P = .018) was associated with late recurrence only in group 2. Cox regression analysis also showed that PVI (HR: 5.6, 95% CI: 1.9-16.56, P = .002) was a significant independent predictor of recurrence only in group 2. Conclusions: Circumferential PVI is more effective than PVI only in patients with a structural change of the atria, that is, a dilated LA. Our study suggests that a successful outcome in dilated LA may depend on wide modification of LA electroanatomical substrates, but wide ablation in less dilated LA may be unnecessary. Different technical strategies according to LA size are required for more a effective outcome.

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