الفهرس 
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Abstract
Atrial fibrillation (AF) is the most common heart rhythm disorder worldwide, it is associated with an increased risk of thromboembolic events, heart failure and hospital admission. Persistent AF lasts for 7 days or more. Catheter ablation outcomes for persistent AF remain suboptimal. While pulmonary vein isolation is the cornerstone of all AF ablation procedures, it is unknown whether additional ablation targets can reduce the rate of recurrence.
The left atrial posterior wall is a promising target for ablation given its embryological and electrophysiological similarities with the pulmonary veins. Previous studies on the posterior wall have so far been inconclusive.
The present work is a prospective and retrospective propensity-matched study that recruited twenty-five patients with persistent atrial fibrillation presenting to the electrophysiology group in Ain Shams University hospitals for first time ablation, in the period between July 2017 and September 2018, as well as collecting retrospective data for 303 patients with persistent atrial fibrillation who had their first time ablations at St George’s University Hospital of London in the period between January 2014 and July 2018. 100 propensity-matched pairs were then compared.
group A (100 patients) underwent pulmonary vein isolation (PVI). The 100 patients in group B received PVI and posterior wall isolation. All patients were followed up 3, 6 and 12 months after the procedure.
The two groups were well matched for baseline patient characteristics. More patients in group A were in sinus rhythm at the start of the procedure, there was a trend towards more termination of AF during ablation in group B. More patients in group B received an additional mitral line and a cavo-tricuspid isthmus line than in group A. Both procedural time and fluoroscopy time were significantly longer in group B.
Periprocedural complications occurred in 5.5% of the study population, half of them were local vascular complications. There was no difference in the incidence of complications between the two study groups.
Atrial tachyarrhythmias recurred in a greater proportion of group A than in group B, the difference reaching statistical significance both at 6 and 12 months of follow up. One year after ablation, 67% of group B and 39% of group A remained in sinus rhythm. Most of recurrences were in the form of atrial fibrillation rather than macro-reentrant tachycardia and reconnection of either the pulmonary veins or the posterior wall was implicated in the majority of patients who went on to receive a second ablation procedure. group B patients had also a longer mean time to recurrence than group A.
Posterior wall isolation was the only factor independently associated with decreased recurrence of atrial tachyarrhythmia after one year of follow up in logistic regression analyses.