Ablation Of Persistent Atrial Fibrillation Combine With Blocking The Connection Between Distal Coronary Sinus And Left Atrium:A Retrospective,Contrast Study

Objective: To evaluate the effectiveness of additional block of the muscular connection between the distal coronary sinus and the left atrium(CSd-LA)on the success rate of catheter ablation during middle-term follow-up among patients with persistent atrial fibrillation(Pers AF).Methods: In this single-center,retrospective study,we reviewed 180 patients with drug-refractory and symptomatic Pers AF underwent ablation for the first time in the Department of Cardiovascular Medicine,from May 2020 to December2021.First,all the patients was completed circumferential pulmonary vein isolation(CPVI)by ablation catheter under the guidance of the Carto 3 mapping system.Atrial fibrillation(AF)would be restored to sinus rhythm(SR)after CPVI.After CPVI,the presence of CSd-LA electrical connection was identified by pacing maneuvers and the activation results of the LA post wall during SR.At the same time,the bipolar map of LA was also obtained.Patients included were divided into three groups according to different surgical procedures: A(CPVI only),B(CPVI +blocking CSd-LA),and C(CPVI + posterior wall BOX ablation).All patients in the study was confirmed with the presence of the electrical connection of the CSd-LA.From 3 months after radiofrequency ablation,the patients were routinely followed up every month.When they had symptoms of palpitation symptom,they were advised to immediately take an electrocardiogram nearby.Follow-up included telephone inquiries,electrocardiogram,and a 24-hour Holter examination.AF recurrence was compared according to the follow-up results.Results: All patients underwent an average follow-up time of 11.1±1.32 months,the proportion of sinus rhythm after the first time catheter ablation was: 32(53.3%)of 60 in group A,44(73.3%)of 60 in group B,48(80%)by follow-up test,P=0.005.Analyses wre also performed between groups: groups A versus B,P=0.023;groups A versus C,P=0.002;groups B versus C,P=0.388;Conclusions: According the results of our study,besides CPVI,additional BOX ablation of the left atrial posterior wall and CDd-LA electrical connection ablation of the distal coronary sinus can improve the follow-up success rate of catheter ablation in patients with Pers AF.The results of this study suggested that the followup success rate of elimination of distal CS musculature with LA was worse than that of BOX ablation in patients with persistent atrial fibrillation,but the statistical difference was not reached.