Endurance Ablation Facilitates Long-lasting Circumferential Pulmonary Vein Isolation and Better Clinical Outcomes in Patients with Paroxysmal Atrial Fibrillation

Yu, Hee Tae; Park, Junbeom; Kim, Tae Hoon; Uhm, Jae Sun; Kim, Jong Youn; Joung, Boyoung; Lee, Moon Hyoung; Pak, Hui Nam

Abstract

BACKGROUND
Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation was found to be related to the reconnection of circumferential pulmonary vein isolation (CPVI). We hypothesized that endurance ablation with moderately increased radiofrequency (RF) power would facilitate long-lasting CPVI and better clinical outcomes.
METHODS
We included 508 patients with paroxysmal AF (76.0% men; mean age, 56.2±9.5 years) who underwent CPVI alone. We compared endurance ablation group (ENDU-abl; n=254, 30 s ablation at each point with 35 W on anterior pulmonary veins (PVs) antrum and 25-30 W on posterior left atrium [LA]) with age-, sex-, and follow-up duration-matched conventional ablation group (CONVabl; n=254, elimination of PV potential [PVP] with 25 W).
RESULTS
1. Total procedure time (p < 0.001) and ablation time (p < 0.001) were significantly longer, and major complication rate was comparable (p=0.088) between ENDU-abl and CONV-abl groups; 2. At 3-month follow-up, heart rate variability, high-frequency (HF) domain (p=0.008) and low-frequency (LF)/HF ratio (p < 0.001) were significantly lower, while LA reverse remodeling was more significant at 1-year follow-up echocardiogram (p=0.013) in ENDU-abl group; 3. During 37.2±17.5 months of follow-up, the clinical recurrence of AF was significantly lower in ENDU-abl group (19.3% vs. 35.4%, log-rank p < 0.001); 4. Among 38 patients who underwent redo-ablation at 15.1±12.1 months, reconnected PVPs were found in 4/11 patients (36.4%) from ENDU-abl group and in 26/27 patients (96.3%) from CONV-abl group (p < 0.001).
CONCLUSION
Despite longer procedure time and relatively higher complication risk, endurance ablation with moderately increased RF power facilitates long-lasting CPVI, more significant autonomic neural remodeling and LA reverse remodeling, and better clinical outcome than conventional ablation in patients with paroxysmal AF.