BACKGROUND: The incidence of atrial fibrillation (AF) after ablation of a cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is high. OBJECTIVE: The purpose of this study was to test the hypothesis that AFL and AF may be initiated by pulmonary vein triggers. This prospective randomized trial tested the efficacy of a standalone pulmonary vein isolation (PVI) in patients with AFL but without AF. METHODS:Patients with AFL but without documented AF were randomly assigned to 1 of 3 treatment groups: (1) antiarrhythmic drugs (AAD), (2) CTI ablation, or (3) circumferential PVI. The primary end-point was defined as any recurrent atrial tachyarrhythmia and the secondary end-point as recurrence of AFL. In case of tachyarrhythmia recurrence in the PVI group, a second PVI was performed to close gaps in the ablation lines. RESULTS: Of the 60 patients, 17 were randomized to AAD, 23 to CTI ablation, and 20 to PVI. During follow-up of 1.42 ± 0.83 years, 14 of 17 patients (82.4%) in the AAD group, 14 of 23 patients (60.9%) in the CTI group, and 2 of 20 patients (10%) in the PVI group reached the primary end-point (P <.001) after a mean of 1.4 PVI procedures per patient. AFL reoccurred in 9 patients (52.9.%) in the AAD group, in 2 patients (8.7%) in the CTI group, and after a single PVI in 3 patients (15%) in the PVI group (P = .003). After closure of gaps, 1 patient (5%) in the PVI group presented with recurrent AFL. CONCLUSION: Pulmonary vein triggers play an important role in AFL. PVI can prevent the recurrence of AFL, even without CTI ablation.
RCT Entities:
BACKGROUND: The incidence of atrial fibrillation (AF) after ablation of a cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is high. OBJECTIVE: The purpose of this study was to test the hypothesis that AFL and AF may be initiated by pulmonary vein triggers. This prospective randomized trial tested the efficacy of a standalone pulmonary vein isolation (PVI) in patients with AFL but without AF. METHODS:Patients with AFL but without documented AF were randomly assigned to 1 of 3 treatment groups: (1) antiarrhythmic drugs (AAD), (2) CTI ablation, or (3) circumferential PVI. The primary end-point was defined as any recurrent atrial tachyarrhythmia and the secondary end-point as recurrence of AFL. In case of tachyarrhythmia recurrence in the PVI group, a second PVI was performed to close gaps in the ablation lines. RESULTS: Of the 60 patients, 17 were randomized to AAD, 23 to CTI ablation, and 20 to PVI. During follow-up of 1.42 ± 0.83 years, 14 of 17 patients (82.4%) in the AAD group, 14 of 23 patients (60.9%) in the CTI group, and 2 of 20 patients (10%) in the PVI group reached the primary end-point (P <.001) after a mean of 1.4 PVI procedures per patient. AFL reoccurred in 9 patients (52.9.%) in the AAD group, in 2 patients (8.7%) in the CTI group, and after a single PVI in 3 patients (15%) in the PVI group (P = .003). After closure of gaps, 1 patient (5%) in the PVI group presented with recurrent AFL. CONCLUSION: Pulmonary vein triggers play an important role in AFL. PVI can prevent the recurrence of AFL, even without CTI ablation.
Authors: Jorge Romero; Juan Carlos Diaz; Luigi Di Biase; Saurabh Kumar; David Briceno; Usha B Tedrow; Carolina R Valencia; Samuel H Baldinger; Bruce Koplan; Laurence M Epstein; Roy John; Gregory F Michaud; William G Stevenson Journal: J Interv Card Electrophysiol Date: 2017-01-09 Impact factor: 1.900
Authors: Dierk Thomas; Lars Eckardt; Heidi L Estner; Malte Kuniss; Christian Meyer; Hans-Ruprecht Neuberger; Philipp Sommer; Daniel Steven; Frederik Voss; Hendrik Bonnemeier Journal: Herzschrittmacherther Elektrophysiol Date: 2016-02-04
Authors: Jonathan Nyong; Guy Amit; Alma J Adler; Onikepe O Owolabi; Pablo Perel; David Prieto-Merino; Pier Lambiase; Juan Pablo Casas; Carlos A Morillo Journal: Cochrane Database Syst Rev Date: 2016-11-22
Authors: Samuel Stempfel; Stefanie Aeschbacher; Steffen Blum; Pascal Meyre; Rebecca Gugganig; Jürg H Beer; Richard Kobza; Michael Kühne; Giorgio Moschovitis; Gianluca Menghini; Jan Novak; Stefan Osswald; Nicolas Rodondi; Elisavet Moutzouri; Matthias Schwenkglenks; Fabienne Witassek; David Conen; Christian Sticherling Journal: Int J Cardiol Heart Vasc Date: 2020-06-16