Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review

Anthony G. Brooks, Martin K. Stiles, Julien Laborderie, Dennis H. Lau, Pawel Kuklik, Nicholas J. Shipp, Li Fern Hsu, Prashanthan Sanders

Research output: Contribution to journalArticle

292 Citations (Scopus)

Abstract

Background: Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes. Objective: The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation. Methods: A systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated. Results: Four studies performed pulmonary vein isolation alone (21%-22% success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38%-40% success) or without confirmed isolation (PVA; n = 2; 37%-56% success). Ten studies performed linear ablation in addition to PVA (n = 5; 11%-74% success) or PVAI (n = 5; 38%-57% success). Three studies performed posterior wall box isolation (n = 3; 44%-50% success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24%-63% success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50%-51% success), PVAI (n = 3; 36%-61% success), or PVAI and linear (n = 1; 68% success) ablation. Five studies performed the stepwise ablation approach (38%-62% success). Conclusion: The variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.

LanguageEnglish
Pages835-846
Number of pages12
JournalHeart Rhythm
Volume7
Issue number6
DOIs
Publication statusPublished - 1 Jun 2010

Keywords

  • Ablation
  • Atrial fibrillation
  • Long-standing persistent atrial fibrillation
  • Systematic review

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Brooks, A. G., Stiles, M. K., Laborderie, J., Lau, D. H., Kuklik, P., Shipp, N. J., ... Sanders, P. (2010). Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review. Heart Rhythm, 7(6), 835-846. https://doi.org/10.1016/j.hrthm.2010.01.017
Brooks, Anthony G. ; Stiles, Martin K. ; Laborderie, Julien ; Lau, Dennis H. ; Kuklik, Pawel ; Shipp, Nicholas J. ; Hsu, Li Fern ; Sanders, Prashanthan. / Outcomes of long-standing persistent atrial fibrillation ablation : A systematic review. In: Heart Rhythm. 2010 ; Vol. 7, No. 6. pp. 835-846.
@article{1c3b3fa92a86490986e041eb434d73d3,
title = "Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review",
abstract = "Background: Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes. Objective: The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation. Methods: A systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated. Results: Four studies performed pulmonary vein isolation alone (21{\%}-22{\%} success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38{\%}-40{\%} success) or without confirmed isolation (PVA; n = 2; 37{\%}-56{\%} success). Ten studies performed linear ablation in addition to PVA (n = 5; 11{\%}-74{\%} success) or PVAI (n = 5; 38{\%}-57{\%} success). Three studies performed posterior wall box isolation (n = 3; 44{\%}-50{\%} success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24{\%}-63{\%} success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50{\%}-51{\%} success), PVAI (n = 3; 36{\%}-61{\%} success), or PVAI and linear (n = 1; 68{\%} success) ablation. Five studies performed the stepwise ablation approach (38{\%}-62{\%} success). Conclusion: The variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.",
keywords = "Ablation, Atrial fibrillation, Long-standing persistent atrial fibrillation, Systematic review",
author = "Brooks, {Anthony G.} and Stiles, {Martin K.} and Julien Laborderie and Lau, {Dennis H.} and Pawel Kuklik and Shipp, {Nicholas J.} and Hsu, {Li Fern} and Prashanthan Sanders",
year = "2010",
month = "6",
day = "1",
doi = "10.1016/j.hrthm.2010.01.017",
language = "English",
volume = "7",
pages = "835--846",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "6",

}

Brooks, AG, Stiles, MK, Laborderie, J, Lau, DH, Kuklik, P, Shipp, NJ, Hsu, LF & Sanders, P 2010, 'Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review', Heart Rhythm, vol. 7, no. 6, pp. 835-846. https://doi.org/10.1016/j.hrthm.2010.01.017

Outcomes of long-standing persistent atrial fibrillation ablation : A systematic review. / Brooks, Anthony G.; Stiles, Martin K.; Laborderie, Julien; Lau, Dennis H.; Kuklik, Pawel; Shipp, Nicholas J.; Hsu, Li Fern; Sanders, Prashanthan.

In: Heart Rhythm, Vol. 7, No. 6, 01.06.2010, p. 835-846.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of long-standing persistent atrial fibrillation ablation

T2 - Heart Rhythm

AU - Brooks, Anthony G.

AU - Stiles, Martin K.

AU - Laborderie, Julien

AU - Lau, Dennis H.

AU - Kuklik, Pawel

AU - Shipp, Nicholas J.

AU - Hsu, Li Fern

AU - Sanders, Prashanthan

PY - 2010/6/1

Y1 - 2010/6/1

N2 - Background: Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes. Objective: The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation. Methods: A systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated. Results: Four studies performed pulmonary vein isolation alone (21%-22% success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38%-40% success) or without confirmed isolation (PVA; n = 2; 37%-56% success). Ten studies performed linear ablation in addition to PVA (n = 5; 11%-74% success) or PVAI (n = 5; 38%-57% success). Three studies performed posterior wall box isolation (n = 3; 44%-50% success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24%-63% success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50%-51% success), PVAI (n = 3; 36%-61% success), or PVAI and linear (n = 1; 68% success) ablation. Five studies performed the stepwise ablation approach (38%-62% success). Conclusion: The variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.

AB - Background: Ablation of long-standing persistent atrial fibrillation (AF) is highly variable, with differing techniques and outcomes. Objective: The purpose of this study was to undertake a systematic review of the literature with regard to the impact of ablation technique on the outcomes of long-standing persistent AF ablation. Methods: A systematic search of the contemporary English scientific literature (from January 1, 1990 to June 1, 2009) in the PubMed database identified 32 studies on persistent/long-standing persistent or long-standing persistent AF ablation (including four randomized controlled trials). Data on single-procedure, drug-free success, multiple procedure success, and pharmaceutically assisted success at longest follow-up were collated. Results: Four studies performed pulmonary vein isolation alone (21%-22% success). Four studies performed pulmonary vein antrum ablation with isolation (PVAI; n = 2; 38%-40% success) or without confirmed isolation (PVA; n = 2; 37%-56% success). Ten studies performed linear ablation in addition to PVA (n = 5; 11%-74% success) or PVAI (n = 5; 38%-57% success). Three studies performed posterior wall box isolation (n = 3; 44%-50% success). Five studies performed complex fractionated atrial electrogram ablation (n = 5; 24%-63% success). Six studies performed complex fractionated atrial electrogram ablation as an adjunct to PVA (n = 2; 50%-51% success), PVAI (n = 3; 36%-61% success), or PVAI and linear (n = 1; 68% success) ablation. Five studies performed the stepwise ablation approach (38%-62% success). Conclusion: The variation in success within and between techniques suggests that the optimal ablation technique for long-standing persistent AF is unclear. Nevertheless, long-standing persistent AF can be effectively treated with a composite of extensive index catheter ablation, repeat procedures, and/or pharmaceuticals.

KW - Ablation

KW - Atrial fibrillation

KW - Long-standing persistent atrial fibrillation

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=77952573158&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2010.01.017

DO - 10.1016/j.hrthm.2010.01.017

M3 - Article

VL - 7

SP - 835

EP - 846

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 6

ER -

Brooks AG, Stiles MK, Laborderie J, Lau DH, Kuklik P, Shipp NJ et al. Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review. Heart Rhythm. 2010 Jun 1;7(6):835-846. https://doi.org/10.1016/j.hrthm.2010.01.017