Pulmonary vein isolation combined with substrate modification for persistent atrial fibrillation treatment in cases with valvular heart diseases

Xinhua Wang ¹, Xu Liu ^1*, Haifeng Shi ¹, Jianing Gu ¹, Yumin Sun ¹, Li Zhou ¹ and Wei Hu ¹

¹ Shanghai Chest Hospital, China

^* To whom correspondence should be addressed. E-mail: xkliuxu{at}126.com.

Accepted 17 November 2008

Abstract

Aims: To compare the efficacy and safety of pulmonary vein isolation combined with substrate modification for persistent atrial fibrillation (AF) treatment in cases with and without valvular heart disease.

Methods and results: 111 cases with persistent AF were enrolled for catheter ablation. 51 cases were with valvular heart disease (group I), and the remaining 60 cases without valve defect were taken as control (group II). Circumferential pulmonary vein isolation (CPVI) and complex fractionated atrial electrograms (CFAEs) ablation were performed guided by CARTO system. There was no significant difference in the total procedure time, pulmonary vein isolation proportion between two groups. AF termination proportion was comparable between two groups by CPVI, but was higher in group II than that in group I by CFAEs ablation. The fluoroscopic time was significantly longer in group I than that in group II. Atrial tachyarrhythmias recurred in 25 (49%) cases of group I and in 27(45%) cases of group II at 4±2 months of follow-up (P=0.67). Re-ablation was performed in 16 cases of group I and in 18 cases of group II (P=0.89). At 12 months of follow-up, totally 34 (66.7%) cases (17 cases with anti-arrhythmic drugs) in group I and 43 (71.7%) cases (14 cases with anti-arrhythmic drugs ) in group II had no recurrence of atrial tachyarrhythmias (P=0.56).

Conclusion: CPVI combined with CFAEs ablation was safe and efficacious for persistent AF treatment in cases with valvular heart disease. The outcomes were comparable with that in cases without valvular heart disease. However, more X-ray exposure was needed to avoid valve prosthesis impairment.