Effect Of Less Than 1 Year Of Persistent Atrial Fibrillation In Different Ablation Strategy On The Success Rate

Objective The catheter radio frequency ablation has become the important means for the treatment of atrial fibrillation.Clinical practice not only to ensure sufficient ablation, so as to improve the success rate, but also to try to reduce unnecessary ablation, to reduce the influence of atrial function and complications.So AF ablation need individual strategy,paroxysmal AF ablation only need circumferential pulmonary vein isolation,but persistent AF need plus substrate ablation. As so far, the classification of AF is about four patterns : paroxysmal AF,persistent AF, long-standing(Ps AF),and permanent AF.But it does not accurately reflect the underlying physiopathologic mechansim, Especially ablation strategy of the patients which are between persistent AF and long-standing is lack of guidance.Therefore this study aims to compare the success rate of different ablation strategy of persistent atrial fibrillation and analysis the characteristics of patients,to provide a reference of AF ablation strategy for clinical doctor.Method 102 patients of persistent atrial fibrillation(less than 1 year)who underwent a first-time catheter ablation in the first affiliated hospital of Dalian medical university were enrolled in the present study from April 2005 to April 2013. All the patients were divided by tow group.A group was performed by PVI(circumferential pulmonary veinisolation), B group was e performed by PVI plus substrate ablation,including additional linear ablation, complex fractionated atrial electrograms ablation. Recurrence rates of the two groups were evaluated through follow-up. Analysis the clinical data(including gender, age, atrial size measured by ultrasonic cardiogram, prevalence of hypertension,prevalence of diabetes melitus,prevalence of coronary heart disease etc.) and conditon of during abltion and after abltion.Results 102 patients of persistent atrial fibrillation were successfully followed up in the study. 32 patients were performed by PVI(circumferential pulmonary vein isolation),21patients(65.6%)maintained sinus rhythmand were free of antiarrhythmics,70 patients were performed by PVI plus substrate ablation,45 patients( 64.2%) maintained sinus rhythm and were free of antiarrhythmics. At the same time we found different ablation strategy had no significant difference on the success rate.(P>0.05).PVI plus substrate ablation need more total ablation time(138.2±30.6min vs.235.4±24.4min P<0.05),and need more X-ray exposure time(12.4±7.8min vs.30.9±6.9min P<0.05).Conclusion less than 1 year of persistent atrial fibrillation,without structure heart disease,which were performed by PVI plus substrate ablation including additional linear ablation, complex fractionated atrial electrograms ablation,can not rise the success rate.And it can add the total ablation time,and X-ray exposure time.