Efficiency of pulmonary vein isolation and ablation of foci of rotary activity in patients with persistent atrial fibrillation

Goal. To determine the possibilities of driver or rotor ablation with the pulmonary veins isolation in patients with persistent forms of atrial fibrillation in reducing the frequency of recurrences in comparison with the classical method of antral isolation of the pulmonary veins.Material and methods. The study included 86 patients who were divided into group A of antral isolation of the pulmonary veins and group B, in which the isolation of the pulmonary veins was expanded by ablation of the rotary regions in the left atrium. Group B underwent non-invasive mapping of the rotors using the AmiCard system immediately before ablation. In this group of patients at the end of each procedure we implanted a Reveal XT cardiac monitor (Medtronic, USA).Results. According to non-invasive mapping data, 98 drivers were identified in 43 patients (the average number per patient was 2.33 ± 1.09). Therefore, 84 rotors of the left atrium localization, of which 23 were in the pulmonary veins and only 14 were in the right atrium. Over two years of follow-up, the advantage of the driver ablation approach with pulmonary veins isolation demonstrated statistical significance (79% of stable sinus rhythm) compared with antral isolation of the pulmonary veins (58% efficiency).Conclusion. Non-invasive mapping and driver ablation in addition to antral isolation of the pulmonary veins increases the efficiency of the procedure and reduces the frequency of recurrence in patients with persistent atrial fibrillation.