Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective Study
ABSTRACT Background Long‐standing persistent atrial fibrillation (AF) often shows resistance to pulmonary vein isolation (PVI) alone. This study aimed to compare the outcomes of catheter ablation targeting electrophysiological substrates versus conventional PVI in patients with long‐standing persist...
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| Format: | Article |
| Language: | English |
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Wiley
2025-08-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.70160 |
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| author | Yuma Gibo Morio Ono Yui Koyanagi Katsuya Yoshihiro Soichiro Usumoto Toshihiko Gokan Toshitaka Okabe Naoei Isomura Mitunori Muto Masaru Shiigai Junko Honye Masahiko Ochiai |
| author_facet | Yuma Gibo Morio Ono Yui Koyanagi Katsuya Yoshihiro Soichiro Usumoto Toshihiko Gokan Toshitaka Okabe Naoei Isomura Mitunori Muto Masaru Shiigai Junko Honye Masahiko Ochiai |
| author_sort | Yuma Gibo |
| collection | DOAJ |
| description | ABSTRACT Background Long‐standing persistent atrial fibrillation (AF) often shows resistance to pulmonary vein isolation (PVI) alone. This study aimed to compare the outcomes of catheter ablation targeting electrophysiological substrates versus conventional PVI in patients with long‐standing persistent AF. Methods This retrospective study included 105 patients with long‐standing persistent AF who underwent initial catheter ablation between June 2021 and June 2023. After propensity score matching (n = 38 each), we compared conventional PVI (conventional group) with additional ablation targeting AF drivers and fragmented potentials (driver and fragmented potentials group). The primary endpoint was AF recurrence lasting > 30 s occurring ≥ 3 months post‐ablation. Results Procedure times were longer in the driver and fragmented potentials group (166.1 ± 35.9 vs. 140.7 ± 50.4 min, p = 0.01). Higher rotational activity was observed in the left atrial appendage and bottom regions in this group. Over a mean follow‐up of 383.5 ± 21.1 days, AF recurrence was numerically lower in the driver and fragmented potentials group (21.1% vs. 36.8%, p = 0.13). Post‐ablation premature atrial contractions were significantly fewer in the driver and fragmented potentials group (p < 0.01). Multivariate analysis identified fragmented potentials and driver activity in the bottom region as independent predictors of AF recurrence (p = 0.02; 95% CI: 1.08–3.12). Conclusions Ablation targeting atrial drivers and fragmented potentials demonstrated a trend toward improved clinical outcomes compared to conventional PVI alone, with reduced AF recurrence and PAC burden. The bottom region of the left atrium appears to be a significant therapeutic target for improving long‐term success in long‐standing persistent AF ablation. |
| format | Article |
| id | doaj-art-6bf0e352451043d49becb80396ebd992 |
| institution | Kabale University |
| issn | 1880-4276 1883-2148 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj-art-6bf0e352451043d49becb80396ebd9922025-08-26T10:38:54ZengWileyJournal of Arrhythmia1880-42761883-21482025-08-01414n/an/a10.1002/joa3.70160Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective StudyYuma Gibo0Morio Ono1Yui Koyanagi2Katsuya Yoshihiro3Soichiro Usumoto4Toshihiko Gokan5Toshitaka Okabe6Naoei Isomura7Mitunori Muto8Masaru Shiigai9Junko Honye10Masahiko Ochiai11Division of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa JapanDivision of Cardiology Kikuna Memorial Hospital Yokohama Kanagawa JapanDivision of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa JapanDivision of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa JapanDivision of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa JapanDivision of Cardiology Kikuna Memorial Hospital Yokohama Kanagawa JapanDivision of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa JapanDivision of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa JapanDivision of Cardiology Kikuna Memorial Hospital Yokohama Kanagawa JapanDivision of Cardiology Kikuna Memorial Hospital Yokohama Kanagawa JapanDivision of Cardiology Kikuna Memorial Hospital Yokohama Kanagawa JapanDivision of Cardiology Showa University Northern Yokohama Hospital Yokohama Kanagawa JapanABSTRACT Background Long‐standing persistent atrial fibrillation (AF) often shows resistance to pulmonary vein isolation (PVI) alone. This study aimed to compare the outcomes of catheter ablation targeting electrophysiological substrates versus conventional PVI in patients with long‐standing persistent AF. Methods This retrospective study included 105 patients with long‐standing persistent AF who underwent initial catheter ablation between June 2021 and June 2023. After propensity score matching (n = 38 each), we compared conventional PVI (conventional group) with additional ablation targeting AF drivers and fragmented potentials (driver and fragmented potentials group). The primary endpoint was AF recurrence lasting > 30 s occurring ≥ 3 months post‐ablation. Results Procedure times were longer in the driver and fragmented potentials group (166.1 ± 35.9 vs. 140.7 ± 50.4 min, p = 0.01). Higher rotational activity was observed in the left atrial appendage and bottom regions in this group. Over a mean follow‐up of 383.5 ± 21.1 days, AF recurrence was numerically lower in the driver and fragmented potentials group (21.1% vs. 36.8%, p = 0.13). Post‐ablation premature atrial contractions were significantly fewer in the driver and fragmented potentials group (p < 0.01). Multivariate analysis identified fragmented potentials and driver activity in the bottom region as independent predictors of AF recurrence (p = 0.02; 95% CI: 1.08–3.12). Conclusions Ablation targeting atrial drivers and fragmented potentials demonstrated a trend toward improved clinical outcomes compared to conventional PVI alone, with reduced AF recurrence and PAC burden. The bottom region of the left atrium appears to be a significant therapeutic target for improving long‐term success in long‐standing persistent AF ablation.https://doi.org/10.1002/joa3.70160atrial fibrillationCARTOFINDERcatheter ablationdriversfragmented |
| spellingShingle | Yuma Gibo Morio Ono Yui Koyanagi Katsuya Yoshihiro Soichiro Usumoto Toshihiko Gokan Toshitaka Okabe Naoei Isomura Mitunori Muto Masaru Shiigai Junko Honye Masahiko Ochiai Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective Study Journal of Arrhythmia atrial fibrillation CARTOFINDER catheter ablation drivers fragmented |
| title | Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective Study |
| title_full | Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective Study |
| title_fullStr | Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective Study |
| title_full_unstemmed | Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective Study |
| title_short | Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long‐Standing Persistent Atrial Fibrillation: A Retrospective Study |
| title_sort | impact of ablation targeting atrial drivers and fragmented potentials on long standing persistent atrial fibrillation a retrospective study |
| topic | atrial fibrillation CARTOFINDER catheter ablation drivers fragmented |
| url | https://doi.org/10.1002/joa3.70160 |
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