This Article Full Text Full Text (PDF) All Versions of this Article: 2/2/113    most recent CIRCEP.108.798447v2 CIRCEP.108.798447v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Di Biase, L. Articles by Natale, A. Search for Related Content PubMed PubMed Citation Articles by Di Biase, L. Articles by Natale, A. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs Related Article

Original Articles

Atrial Fibrillation Ablation Strategies for Paroxysmal Patients

Randomized Comparison Between Different Techniques

Luigi Di Biase, MD; Claude S. Elayi, MD; Tamer S. Fahmy, MD; David O. Martin, MD; Chi Keong Ching, MD; Conor Barrett, MD; Rong Bai, MD; Dimpi Patel, DO; Yaariv Khaykin, MD; Richard Hongo, MD; Steven Hao, MD; Salwa Beheiry, RN; Gemma Pelargonio, MD; Antonio Dello Russo, MD; Michela Casella, MD; Pietro Santarelli, MD; Domenico Potenza, MD; Raffaele Fanelli, MD; Raimondo Massaro, MD; Paul Wang, MD; Amin Al-Ahmad, MD; Mauricio Arruda, MD; Sakis Themistoclakis, MD; Aldo Bonso, MD; Antonio Rossillo, MD; Antonio Raviele, MD; Robert A. Schweikert, MD; David J. Burkhardt, MD and Andrea Natale, MD

From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the Catholic University (G.P., A.D.R., M.C., P.S.), Rome, Italy; the Hospital Umberto I Mestre (S.T., A.B., A. Rossillo, A. Raviele), Italy; Casa Sollievo Della Sofferenza (D.P., R.F., R.M.), San Giovanni Rotondo, Foggia, Italy; Stanford University (P.W., A.A.-A., A.N.), Palo Alto, Calif; the Department of Cardiology (C.K.C.), National Heart Centre Singapore Mistri Wing, Singapore; Case Western Reserve University School of Medicine (M.A., A.N.), Cleveland, Ohio; the Department of Critical Care Medicine (T.S.F.), Cairo University, Cairo, Egypt; Cardiac Arrhythmia Service (C.B.), Massachusetts General Hospital, Heart Center, Boston, Mass; Department of Internal Medicine (B.R.), Tong-Ji Hospital, Tong-Ji Medical College, Huazhong University of Science and Technology, Wuhan, China; Akron General Hospital (R.A.S.), Akron, Ohio.

Correspondence to Andrea Natale, MD, Texas Cardiac Arrhythmia Institute, St David’s Medical Center, 1015 East 32nd Street, Austin, TX 78705. E-mail dr.natale{at}gmail.com

Received March 19, 2008; accepted February 11, 2009.

Background— Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF.

Methods and Results— One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAEs group (P<0.001) after a single procedure and with antiarrhythmic drugs.

Conclusion— No difference in terms of success rate was seen between PVAI alone and PVAI associated with defragmentation. CFAEs ablation alone had the smallest impact on AF recurrences at 1-year follow-up. These results suggest that antral isolation is sufficient to treat most patients with paroxysmal AF.

Key Words: catheter ablation • paroxysmal atrial fibrillation • pulmonary vein antrum isolation • radiofrequency • randomized study • complex fractionated atrial electrograms or defragmentation

---

 

CLINICAL PERSPECTIVE

Related Article

Atrial Fibrillation Ablation Strategies for Paroxysmal Patients: Randomized Comparison Between Different Techniques

Luigi Di Biase, Claude S. Elayi, Tamer S. Fahmy, David O. Martin, Chi Keong Ching, Conor Barrett, Rong Bai, Dimpi Patel, Yaariv Khaykin, Richard Hongo, Steven Hao, Salwa Beheiry, Gemma Pelargonio, Antonio Dello Russo, Michela Casella, Pietro Santarelli, Domenico Potenza, Raffaele Fanelli, Raimondo Massaro, Paul Wang, Amin Al-Ahmad, Mauricio Arruda, Sakis Themistoclakis, Aldo Bonso, Antonio Rossillo, Antonio Raviele, Robert A. Schweikert, David J. Burkhardt, and Andrea Natale
Circ Arrhythm Electrophysiol 2009 2: 113-119. [Abstract] [Full Text] [PDF]