Acute response and rhythm outcome after the patchy late-gadolinium
enhancement site catheter ablation in patients with persistent atrial
Background: Computer simulation model demonstrated that atrial
fibrillation (AF) driver attached to the patchy fibrosis assessed by
late gadolinium enhancement magnetic resonance imaging (LGE-MRI).
However, it has not been well elucidated in patients with persistent AF.
The aim of this study is to investigate whether radiofrequency (RF)
application on the patchy LGE site (PLS) could terminate AF or convert
to atrial tachycardia (AT) and improve the rhythm outcome. Methods: A
total of 31consecutive persistent AF patients with PLS were enrolled
(PLS ablation group, mean age: 69 ± 8 years, mean left atrial diameter:
42 ± 6 mm). AF direct termination or AT conversion during RF application
on the PLS were defined as favorable response. The rhythm outcome was
compared between the PLS ablation group and the propensity matched
conventional ablation group. Results: Favorable response was found in 15
(48%) of 31 patients (AF termination in 7, AT conversion in 8
patients). AF recurrence at 12 months follow-up was significantly less
in the PLS group as compared to the control group (4 (13%) of 31
patients vs. 11 (35%) of 31 patients, log-rank p = 0.019). In patients
with favorable response, AT recurred in 1 (7%) of 15 patients but AF.
Conclusions: The PLS ablation could terminate AF or convert to AT in
half of the patients and improve the rhythm outcome as compared to the
conventional ablation. No AF recurrence was documented in patients with
a favorable response.