Abstract
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.
Key Words : atrial fibrillation; fibrosis; late-gadolinium
enhancement MRI; catheter ablation; rhythm outcome