on February 18, 2009
Published online before print February 18, 2009, doi: 10.1161/CIRCEP.108.798447
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original Article |
Atrial Fibrillation Ablation Strategies for Paroxysmal Patients: randomized comparison between different techniques.
1 St. David's Medical Center, TX and University of Foggia;
2 University of Kentucky;
3 Cairo University;
4 Cleveland Clinic;
5 National Heart Centre Singapore;
6 Southlake Regional Health Center, Ontario;
7 Massachusetts General Hospital;
8 Huazhong University of Science and Technology;
9 St. David's Medical Center, Texas;
10 Sutter Pacific Heart Centers, California;
11 Catholic University, Rome;
12 Casa Sollievo Della Sofferenza, Foggia;
13 Stanford University;
14 Case Western Reserve University;
15 Hospital Umberto I Mestre;
16 Akron General Hospital;
17 St. David's Medical Center, Texas; Stanford University; Case Western Reserve University
18 E-mail: dr.natale{at}gmail.com
Background—Whether different ablation strategies affect paroxysmal AF long term freedom from AF/AT 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 and three (103) consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory (EP lab) in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI) (35 pts) versus bi-atrial ablation of the complex fractionated atrial electrograms (CFAEs) (34 pts) versus PVAI followed by CFAEs (34 pts). Patients were given event recorder(s) and followed up at 3, 6, 9, 12 and 15 months post ablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, LA size and EF. At one year follow up, freedom from AF/AT was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAE group (p< 0.001) after a single procedure and with AADs.
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 one-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
Related Article
Circ Arrhythm Electrophysiol 2009 2: 113-119.