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The Effect of the Enhanced Endpoint of Pulmonary Vein Isolation on the Long-Term Success Rate of Radiofrequency Ablation for Atrial Fibrillation

Authors Chen J, Chen Q, Zhang F, Chen X, Xu Z, Jiang Q, Sun X, Li J, Chen L, Wang W

Received 3 December 2020

Accepted for publication 18 January 2021

Published 1 March 2021 Volume 2021:14 Pages 697—707

DOI https://doi.org/10.2147/IJGM.S294033

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Jianhua Chen,1,* Quanhe Chen,2,* Feilong Zhang,1 Xuehai Chen,1 Zhe Xu,1 Qiong Jiang,1 Xudong Sun,1 Jinguo Li,1 Lianglong Chen,1 Weiwei Wang1

1Department of Cardiology, Fujian Medical University Union Hospital & Fujian Provincial Institute of Coronary Disease, Fuzhou, People’s Republic of China; 2Union Clinic Medical College, Fujian Medical University, Fuzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Weiwei Wang
Department of Cardiology, Fujian Medical University Union Hospital & Fujian Provincial Institute of Coronary Disease, No. 29 of Xinquan Road, Gulou District, Fuzhou, 350001, People’s Republic of China
Tel +86 591 86218022
Fax +86 591 83322156
Email [email protected]

Objective: This study aimed to investigate whether the enhanced endpoint of pulmonary vein isolation (PVI; intravenous injection of adenosine-triphosphate [ATP] + pacing capture + supplemental ablation) after initial PVI can reduce the long-term recurrence rate of atrial fibrillation (AF) after PVI.
Methods: Patients with paroxysmal or persistent AF undergoing catheter ablation treatment were enrolled in this study and divided into three groups according to the surgical endpoint: (1) group 1 (n = 92), in which patients were observed for 30 minutes after the initial PVI and pulmonary vein–left atrium (PV–LA) electrical conduction had not recovered; (2) group 2 (n = 99), in which patients were observed for 30 minutes after the initial PVI, then intravenously injected with ATP, and PV–LA electrical conduction had not recovered; and (3) group 3 (n = 102), in which patients were observed for 30 minutes after the initial PVI, then intravenously injected with ATP + treated with ablation line pacing, and the atrium could not be captured.
Results: Patients were followed up for 12 months after the operation. Twenty-eight patients in group 1 (30.4%), 19 patients in group 2 (19.2%), and 10 patients in group 3 (9.8%) developed a recurrence of AF. The difference between groups 1 and 3 was statistically significant (p < 0.001). At 12 months after the operation, the thickness of the left atrium, the posterior wall of the left ventricle, and the ventricular septum of the three groups of patients were significantly thinner than before the operation. Furthermore, the left ventricular ejection fraction had increased (p < 0.05 for all), and the pulmonary artery pressure had decreased (p < 0.001).
Conclusion: For patients with paroxysmal AF or persistent AF, the enhanced endpoint of PVI after the initial PVI can reduce the long-term recurrence rate of AF after PVI.

Keywords: ablation, pacing, adenosine, atrial fibrillation

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