Effect of pulmonary vein isolation on atrial fibrillation recurrence after accessory pathway ablation in patients with Wolff-Parkinson-White syndrome.
Wolff-Parkinson-White syndrome
accessory pathway ablation
advanced interatrial block
atrial fibrillation
pulmonary vein isolation
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
07
07
2020
revised:
08
09
2020
accepted:
17
09
2020
pubmed:
2
10
2020
medline:
10
8
2021
entrez:
1
10
2020
Statut:
ppublish
Résumé
Although successful ablation of the accessory pathway (AP) eliminates atrial fibrillation (AF) in some of patients with Wolff-Parkinson-White (WPW) syndrome and paroxysmal AF, in other patients it can recur. Whether adding pulmonary vein isolation (PVI) after successful AP ablation effectively prevents AF recurrence in patients with WPW syndrome is unknown. We retrospectively studied 160 patients (102 men, 58 women; mean age, 46 ± 14 years) with WPW syndrome and paroxysmal AF who underwent AP ablation, namely 103 (64.4%) undergoing only AP ablation (AP group) and 57 (35.6%) undergoing AP ablation plus PVI (AP + PVI group). Advanced interatrial block (IAB) was defined as a P-wave duration of >120 ms and biphasic (±) morphology in the inferior leads, using 12-lead electrocardiography (ECG). During the mean follow-up period of 30.9 ± 9.2 months (range, 3-36 months), 22 patients (13.8%) developed AF recurrence. The recurrence rate did not differ in patients in the AP + PVI group and AP group (15.5% vs 10.5%, respectively; P = .373). Univariable and multivariable Cox regression analyses showed that PVI was not associated with the risk of AF recurrence (hazard ratio, 0.66; 95% confidence interval, 0.26-1.68; P = .380). In WPW patients with advanced IAB, the recurrence rate was lower in patients in the AP + PVI group vs the AP group (90% vs 33.3%, respectively; P = .032). PVI after successful AP ablation significantly reduced the AF recurrence rate in WPW patients with advanced IAB. Screening of a resting 12-lead ECG immediately after AP ablation helps identify patients in whom PVI is beneficial.
Sections du résumé
BACKGROUND
BACKGROUND
Although successful ablation of the accessory pathway (AP) eliminates atrial fibrillation (AF) in some of patients with Wolff-Parkinson-White (WPW) syndrome and paroxysmal AF, in other patients it can recur.
HYPOTHESIS
OBJECTIVE
Whether adding pulmonary vein isolation (PVI) after successful AP ablation effectively prevents AF recurrence in patients with WPW syndrome is unknown.
METHODS
METHODS
We retrospectively studied 160 patients (102 men, 58 women; mean age, 46 ± 14 years) with WPW syndrome and paroxysmal AF who underwent AP ablation, namely 103 (64.4%) undergoing only AP ablation (AP group) and 57 (35.6%) undergoing AP ablation plus PVI (AP + PVI group). Advanced interatrial block (IAB) was defined as a P-wave duration of >120 ms and biphasic (±) morphology in the inferior leads, using 12-lead electrocardiography (ECG).
RESULTS
RESULTS
During the mean follow-up period of 30.9 ± 9.2 months (range, 3-36 months), 22 patients (13.8%) developed AF recurrence. The recurrence rate did not differ in patients in the AP + PVI group and AP group (15.5% vs 10.5%, respectively; P = .373). Univariable and multivariable Cox regression analyses showed that PVI was not associated with the risk of AF recurrence (hazard ratio, 0.66; 95% confidence interval, 0.26-1.68; P = .380). In WPW patients with advanced IAB, the recurrence rate was lower in patients in the AP + PVI group vs the AP group (90% vs 33.3%, respectively; P = .032).
CONCLUSIONS
CONCLUSIONS
PVI after successful AP ablation significantly reduced the AF recurrence rate in WPW patients with advanced IAB. Screening of a resting 12-lead ECG immediately after AP ablation helps identify patients in whom PVI is beneficial.
Identifiants
pubmed: 33002216
doi: 10.1002/clc.23470
pmc: PMC7724218
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1511-1516Informations de copyright
© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
Références
J Cardiol. 2016 Dec;68(6):485-491
pubmed: 26917195
J Cardiovasc Electrophysiol. 1998 Feb;9(2):141-51
pubmed: 9511888
Am J Cardiol. 1992 Feb 15;69(5):493-7
pubmed: 1736613
Eur Heart J. 2001 Mar;22(5):423-7
pubmed: 11207084
Circulation. 1999 Aug 3;100(5):e31-7
pubmed: 10430823
J Cardiol. 2016 Oct;68(4):352-6
pubmed: 26611936
Europace. 2015 Jan;17(1):117-22
pubmed: 25013013
J Cardiovasc Electrophysiol. 2002 Mar;13(3):223-9
pubmed: 11942586
J Interv Card Electrophysiol. 2014 Nov;41(2):169-75
pubmed: 25227867
Clin Cardiol. 2020 Dec;43(12):1511-1516
pubmed: 33002216
J Cardiovasc Electrophysiol. 2012 Mar;23(3):280-6
pubmed: 22035173
Clin Cardiol. 2019 Jun 26;:
pubmed: 31243791
J Cardiovasc Electrophysiol. 2006 Dec;17(12):1263-70
pubmed: 17239094
Eur Heart J. 2016 Oct 7;37(38):2893-2962
pubmed: 27567408
Br Heart J. 1988 May;59(5):578-80
pubmed: 3382570
Europace. 2002 Apr;4(2):201-6
pubmed: 12135254
Circulation. 2014 Dec 2;130(23):2071-104
pubmed: 24682348
J Electrocardiol. 2012 Sep;45(5):445-51
pubmed: 22920783
Europace. 2008 Mar;10(3):294-302
pubmed: 18308751
Circulation. 1985 Jul;72(1):161-9
pubmed: 4006127