AIMS: Circumferential pulmonary vein isolation (PVI) is the current standard of interventional atrial fibrillation (Afib) therapy. However, recurrence rate of Afib varies considerably after ablation between different series and is mainly attributed to the recovery of pulmonary vein (PV) conduction after initial successful PVI. STUDY HYPOTHESIS: Waiting longer during the initial PVI procedure and re-ablating any re-conduction may prolong procedure duration but should improve outcome with fewer relapses during follow-up. METHODS AND RESULTS:Circumferential PVI with radiofrequency energy according to an electro-anatomical reconstruction of the left atrium and the PV ostia. A total of 107 consecutive patients who were presented to our hospital for circumferential PVI, were randomly assigned to prolongation of the waiting period (n= 54, 50.5%) or immediate termination of the procedure after initial successful isolation (n= 53, 49.5%). Ablation was started in an alternating manner at the lateral (n= 51, 47.7%) or septal veins (n= 56, 52.3%). Patients had paroxysmal (n= 70, 65.4%) and persistent Afib (n= 37, 34.6%). A total of 36 gaps occurred in 27 patients (50%) during 1 h after initial successful PVI. Without any blanking period 24 patients (44.4%) were free of any arrhythmia in the wait group and 23 patients (43.4%) in the stop group. Sixteen patients (29.6 and 30.2%) underwentre-ablation for symptomatic recurrences of atrial arrhythmias in each group. With re-ablation 45 patients (83.3%) were free of any arrhythmia in the wait group and 46 patients (86.8%) in the stop group. In addition there was no difference in the type of recurring arrhythmia in both groups. CONCLUSION: The risk of early PV recovery was considerable. However, immediate re-ablation of early re-conduction did not result in a reduced recurrence rate of Afib during follow-up.
RCT Entities:
AIMS: Circumferential pulmonary vein isolation (PVI) is the current standard of interventional atrial fibrillation (Afib) therapy. However, recurrence rate of Afib varies considerably after ablation between different series and is mainly attributed to the recovery of pulmonary vein (PV) conduction after initial successful PVI. STUDY HYPOTHESIS: Waiting longer during the initial PVI procedure and re-ablating any re-conduction may prolong procedure duration but should improve outcome with fewer relapses during follow-up. METHODS AND RESULTS: Circumferential PVI with radiofrequency energy according to an electro-anatomical reconstruction of the left atrium and the PV ostia. A total of 107 consecutive patients who were presented to our hospital for circumferential PVI, were randomly assigned to prolongation of the waiting period (n= 54, 50.5%) or immediate termination of the procedure after initial successful isolation (n= 53, 49.5%). Ablation was started in an alternating manner at the lateral (n= 51, 47.7%) or septal veins (n= 56, 52.3%). Patients had paroxysmal (n= 70, 65.4%) and persistent Afib (n= 37, 34.6%). A total of 36 gaps occurred in 27 patients (50%) during 1 h after initial successful PVI. Without any blanking period 24 patients (44.4%) were free of any arrhythmia in the wait group and 23 patients (43.4%) in the stop group. Sixteen patients (29.6 and 30.2%) underwent re-ablation for symptomatic recurrences of atrial arrhythmias in each group. With re-ablation 45 patients (83.3%) were free of any arrhythmia in the wait group and 46 patients (86.8%) in the stop group. In addition there was no difference in the type of recurring arrhythmia in both groups. CONCLUSION: The risk of early PV recovery was considerable. However, immediate re-ablation of early re-conduction did not result in a reduced recurrence rate of Afib during follow-up.
Authors: Joris R de Groot; Wouter R Berger; Sébastien P J Krul; WimJan van Boven; Sacha P Salzberg; Antoine H G Driessen Journal: J Atr Fibrillation Date: 2013-10-31
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: J Interv Card Electrophysiol Date: 2017-10 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: J Arrhythm Date: 2017-09-15