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Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis
Background The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV‐Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV‐Comp isolation...
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| Published in: | Pacing and clinical electrophysiology 2020-01, Vol.43 (1), p.68-77 |
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| container_title | Pacing and clinical electrophysiology |
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| creator | Elbatran, Ahmed I Gallagher, Mark M Li, Anthony Sohal, Manav Bajpai, Abhay Samir, Rania Tawfik, Mazen Nabil, Ahmed Abou‐Elmaaty Nabih, Mervat Saba, Magdi M |
| description | Background
The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV‐Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV‐Comp isolation is an alternative strategy for persistent AF ablation.
Methods
Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n = 100; PV‐Comp isolation, n = 100) were selected by propensity score matching. Both groups were followed up for 1 year.
Results
At 6‐ and 12‐month follow‐up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P = .006) and 33 patients (P |
| doi_str_mv | 10.1111/pace.13852 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2322741322</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2338888055</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3572-eef6dc35fe62201a39b75df1ca71f8cfac76fe7b2077661fef30586ef2a0f2e3</originalsourceid><addsrcrecordid>eNp9kU1OHDEQhS0UBBOSTQ4QWcoGRWrin3Hbw240IgEJiSzYtzyecjDqtjt2N2h2HIFlzpeTpDoDUcgitbCt8veeyn6EvOPshGN96q2DEy6NEntkxtWcVYarxSsyY3yuKyPN4pC8LuWWMVazuTogh5IbZnitZuTHRUmtHUL8RocboBCHkIH2Y9ulaPOW3kFMY6EudX2KeIuNXLARXsj-5kMs1KdMewRDGSaNHXKwLfVhnUM7yVI8pUva59RDLGHY_nx47OzgbmBDbbTtFoVvyL63bYG3T_sRuf58dr06ry6vvlyslpeVk0qLCsDXGzx6qIVg3MrFWquN585q7o3z1unag14LpnVdcw9eMmVq8MIyL0AekeOdLQ7zfYQyNF0oDnDKCPjwRkgh9JzjiuiHf9DbNGYcd6KkwWJKIfVxR7mcSsngmz6HDr-m4ayZ4mqmuJrfcSH8_slyXHew-YM-54MA3wH3oYXtf6yar8vV2c70F9uSpas</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2338888055</pqid></control><display><type>article</type><title>Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis</title><source>Wiley</source><source>SPORTDiscus with Full Text</source><creator>Elbatran, Ahmed I ; Gallagher, Mark M ; Li, Anthony ; Sohal, Manav ; Bajpai, Abhay ; Samir, Rania ; Tawfik, Mazen ; Nabil, Ahmed ; Abou‐Elmaaty Nabih, Mervat ; Saba, Magdi M</creator><creatorcontrib>Elbatran, Ahmed I ; Gallagher, Mark M ; Li, Anthony ; Sohal, Manav ; Bajpai, Abhay ; Samir, Rania ; Tawfik, Mazen ; Nabil, Ahmed ; Abou‐Elmaaty Nabih, Mervat ; Saba, Magdi M</creatorcontrib><description>Background
The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV‐Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV‐Comp isolation is an alternative strategy for persistent AF ablation.
Methods
Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n = 100; PV‐Comp isolation, n = 100) were selected by propensity score matching. Both groups were followed up for 1 year.
Results
At 6‐ and 12‐month follow‐up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P = .006) and 33 patients (P < .001) in PV‐Comp isolation group, respectively. PV‐Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV‐Comp isolation: 10 months, log‐rank P < .001) and a lower probability of recurrence (odds ratio [OR] = 0.32; 95% confidence of interval [CI] = 0.18‐0.56, P < .001), with no increase in procedural complications (PVI: 5 of 100, PV‐Comp isolation: 6 of 100, P = .76). Procedure duration was longer in PV‐Comp isolation group (PVI: 186 ± 42 min, PV‐Comp isolation: 238 ± 44 min, P < .001), as well as fluoroscopy time (PVI: 22 ± 16 min, PV‐Comp isolation: 31 ± 21 min, P = .001).
Conclusion
PV‐Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.13852</identifier><identifier>PMID: 31808165</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Atrial Fibrillation - surgery ; Cardiac arrhythmia ; catheter ablation ; Catheter Ablation - methods ; Egypt ; Electrocardiography ; Epicardial Mapping ; Female ; Fibrillation ; Fluoroscopy ; Humans ; London ; Male ; Middle Aged ; persistent atrial fibrillation ; posterior wall isolation ; Propensity Score ; pulmonary vein isolation ; Pulmonary Veins - surgery ; pulmonary venous component ; Recurrence ; Tachyarrhythmia ; Tachycardia ; Veins & arteries</subject><ispartof>Pacing and clinical electrophysiology, 2020-01, Vol.43 (1), p.68-77</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><rights>2020 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3572-eef6dc35fe62201a39b75df1ca71f8cfac76fe7b2077661fef30586ef2a0f2e3</citedby><cites>FETCH-LOGICAL-c3572-eef6dc35fe62201a39b75df1ca71f8cfac76fe7b2077661fef30586ef2a0f2e3</cites><orcidid>0000-0003-2709-1806</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31808165$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elbatran, Ahmed I</creatorcontrib><creatorcontrib>Gallagher, Mark M</creatorcontrib><creatorcontrib>Li, Anthony</creatorcontrib><creatorcontrib>Sohal, Manav</creatorcontrib><creatorcontrib>Bajpai, Abhay</creatorcontrib><creatorcontrib>Samir, Rania</creatorcontrib><creatorcontrib>Tawfik, Mazen</creatorcontrib><creatorcontrib>Nabil, Ahmed</creatorcontrib><creatorcontrib>Abou‐Elmaaty Nabih, Mervat</creatorcontrib><creatorcontrib>Saba, Magdi M</creatorcontrib><title>Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Background
The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV‐Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV‐Comp isolation is an alternative strategy for persistent AF ablation.
Methods
Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n = 100; PV‐Comp isolation, n = 100) were selected by propensity score matching. Both groups were followed up for 1 year.
Results
At 6‐ and 12‐month follow‐up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P = .006) and 33 patients (P < .001) in PV‐Comp isolation group, respectively. PV‐Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV‐Comp isolation: 10 months, log‐rank P < .001) and a lower probability of recurrence (odds ratio [OR] = 0.32; 95% confidence of interval [CI] = 0.18‐0.56, P < .001), with no increase in procedural complications (PVI: 5 of 100, PV‐Comp isolation: 6 of 100, P = .76). Procedure duration was longer in PV‐Comp isolation group (PVI: 186 ± 42 min, PV‐Comp isolation: 238 ± 44 min, P < .001), as well as fluoroscopy time (PVI: 22 ± 16 min, PV‐Comp isolation: 31 ± 21 min, P = .001).
Conclusion
PV‐Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications.</description><subject>Aged</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiac arrhythmia</subject><subject>catheter ablation</subject><subject>Catheter Ablation - methods</subject><subject>Egypt</subject><subject>Electrocardiography</subject><subject>Epicardial Mapping</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Fluoroscopy</subject><subject>Humans</subject><subject>London</subject><subject>Male</subject><subject>Middle Aged</subject><subject>persistent atrial fibrillation</subject><subject>posterior wall isolation</subject><subject>Propensity Score</subject><subject>pulmonary vein isolation</subject><subject>Pulmonary Veins - surgery</subject><subject>pulmonary venous component</subject><subject>Recurrence</subject><subject>Tachyarrhythmia</subject><subject>Tachycardia</subject><subject>Veins & arteries</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kU1OHDEQhS0UBBOSTQ4QWcoGRWrin3Hbw240IgEJiSzYtzyecjDqtjt2N2h2HIFlzpeTpDoDUcgitbCt8veeyn6EvOPshGN96q2DEy6NEntkxtWcVYarxSsyY3yuKyPN4pC8LuWWMVazuTogh5IbZnitZuTHRUmtHUL8RocboBCHkIH2Y9ulaPOW3kFMY6EudX2KeIuNXLARXsj-5kMs1KdMewRDGSaNHXKwLfVhnUM7yVI8pUva59RDLGHY_nx47OzgbmBDbbTtFoVvyL63bYG3T_sRuf58dr06ry6vvlyslpeVk0qLCsDXGzx6qIVg3MrFWquN585q7o3z1unag14LpnVdcw9eMmVq8MIyL0AekeOdLQ7zfYQyNF0oDnDKCPjwRkgh9JzjiuiHf9DbNGYcd6KkwWJKIfVxR7mcSsngmz6HDr-m4ayZ4mqmuJrfcSH8_slyXHew-YM-54MA3wH3oYXtf6yar8vV2c70F9uSpas</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Elbatran, Ahmed I</creator><creator>Gallagher, Mark M</creator><creator>Li, Anthony</creator><creator>Sohal, Manav</creator><creator>Bajpai, Abhay</creator><creator>Samir, Rania</creator><creator>Tawfik, Mazen</creator><creator>Nabil, Ahmed</creator><creator>Abou‐Elmaaty Nabih, Mervat</creator><creator>Saba, Magdi M</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2709-1806</orcidid></search><sort><creationdate>202001</creationdate><title>Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis</title><author>Elbatran, Ahmed I ; Gallagher, Mark M ; Li, Anthony ; Sohal, Manav ; Bajpai, Abhay ; Samir, Rania ; Tawfik, Mazen ; Nabil, Ahmed ; Abou‐Elmaaty Nabih, Mervat ; Saba, Magdi M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3572-eef6dc35fe62201a39b75df1ca71f8cfac76fe7b2077661fef30586ef2a0f2e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiac arrhythmia</topic><topic>catheter ablation</topic><topic>Catheter Ablation - methods</topic><topic>Egypt</topic><topic>Electrocardiography</topic><topic>Epicardial Mapping</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Fluoroscopy</topic><topic>Humans</topic><topic>London</topic><topic>Male</topic><topic>Middle Aged</topic><topic>persistent atrial fibrillation</topic><topic>posterior wall isolation</topic><topic>Propensity Score</topic><topic>pulmonary vein isolation</topic><topic>Pulmonary Veins - surgery</topic><topic>pulmonary venous component</topic><topic>Recurrence</topic><topic>Tachyarrhythmia</topic><topic>Tachycardia</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elbatran, Ahmed I</creatorcontrib><creatorcontrib>Gallagher, Mark M</creatorcontrib><creatorcontrib>Li, Anthony</creatorcontrib><creatorcontrib>Sohal, Manav</creatorcontrib><creatorcontrib>Bajpai, Abhay</creatorcontrib><creatorcontrib>Samir, Rania</creatorcontrib><creatorcontrib>Tawfik, Mazen</creatorcontrib><creatorcontrib>Nabil, Ahmed</creatorcontrib><creatorcontrib>Abou‐Elmaaty Nabih, Mervat</creatorcontrib><creatorcontrib>Saba, Magdi M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elbatran, Ahmed I</au><au>Gallagher, Mark M</au><au>Li, Anthony</au><au>Sohal, Manav</au><au>Bajpai, Abhay</au><au>Samir, Rania</au><au>Tawfik, Mazen</au><au>Nabil, Ahmed</au><au>Abou‐Elmaaty Nabih, Mervat</au><au>Saba, Magdi M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>2020-01</date><risdate>2020</risdate><volume>43</volume><issue>1</issue><spage>68</spage><epage>77</epage><pages>68-77</pages><issn>0147-8389</issn><eissn>1540-8159</eissn><abstract>Background
The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV‐Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV‐Comp isolation is an alternative strategy for persistent AF ablation.
Methods
Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n = 100; PV‐Comp isolation, n = 100) were selected by propensity score matching. Both groups were followed up for 1 year.
Results
At 6‐ and 12‐month follow‐up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P = .006) and 33 patients (P < .001) in PV‐Comp isolation group, respectively. PV‐Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV‐Comp isolation: 10 months, log‐rank P < .001) and a lower probability of recurrence (odds ratio [OR] = 0.32; 95% confidence of interval [CI] = 0.18‐0.56, P < .001), with no increase in procedural complications (PVI: 5 of 100, PV‐Comp isolation: 6 of 100, P = .76). Procedure duration was longer in PV‐Comp isolation group (PVI: 186 ± 42 min, PV‐Comp isolation: 238 ± 44 min, P < .001), as well as fluoroscopy time (PVI: 22 ± 16 min, PV‐Comp isolation: 31 ± 21 min, P = .001).
Conclusion
PV‐Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31808165</pmid><doi>10.1111/pace.13852</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-2709-1806</orcidid></addata></record> |
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| subjects | Aged Atrial Fibrillation - surgery Cardiac arrhythmia catheter ablation Catheter Ablation - methods Egypt Electrocardiography Epicardial Mapping Female Fibrillation Fluoroscopy Humans London Male Middle Aged persistent atrial fibrillation posterior wall isolation Propensity Score pulmonary vein isolation Pulmonary Veins - surgery pulmonary venous component Recurrence Tachyarrhythmia Tachycardia Veins & arteries |
| title | Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity‐matched analysis |
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