Methods:
Clinical outcomes were evaluated in 222 patients undergoing first-time
catheter ablation of NPAF with a CFS RFA catheter (SmartTouch, Biosense
Webster) at New York University (NYU) Langone Health. Group 1 included
111 patients that underwent PVAI followed by stepwise linear ablation
between July 2014 and September 2015, while Group 2 included 111
patients that underwent PVAI followed by LA PWI between October 2015 and
August 2016. Our group changed ablation strategies from a linear
stepwise approach to LA PWI and this research evaluates the
effectiveness of this change. Index and repeat ablations were performed
by the same five high-volume (>150 AF ablations per year)
operators in each cohort. NPAF was defined as AF lasting more than seven
days or a duration of greater than 48 hours requiring cardioversion.9 The incidence of atrial arrhythmia recurrence of
>30 seconds in duration was evaluated in each cohort and
stratified by AF or atrial tachycardia (AT) as well as by persistence of
the arrhythmia. Amiodarone was discontinued at least one month prior to
ablation and any antiarrhythmics started after the ablation were
discontinued within 4 to 8 weeks after the procedure. After the index
ablation, patients were scheduled for follow up in-office visits at 3,
6, 9, and 12 months, and every 6 months thereafter. At each visit, study
assessments included a detailed medical history, physical exam, and
12-lead ECG. A 2-week mobile cardiac outpatient telemetry (MCOT) monitor
was performed prior to each scheduled in-office visit in patients
without implanted arrhythmia monitoring. Arrhythmia recurrence was
defined as either (1) a sustained atrial arrhythmia within the 90-day
blanking period that required a repeat ablation or (2) an atrial
arrhythmia that occurred after the 90-day blanking period and was
captured on a resting 12-lead ECG or lasted longer than 30 seconds on an
ambulatory monitor. Persistence of AF or AT after index ablation was
defined by the need for direct current cardioversion after the blanking
period or sustained AF or AT at the time of repeat ablation. Patient
follow-up was censored for the purposes of survival analyses at time of
last follow up if less than 3 years after their first procedure, but did
not have a second ablation.