Alex J A McLellan1, Liang-Han Ling1, Sonia Azzopardi2, Geraldine A Lee2, Geoffrey Lee1, Saurabh Kumar1, Michael C G Wong1, Tomos E Walters1, Justin M Lee3, Khang-Li Looi4, Karen Halloran3, Martin K Stiles5, Nigel A Lever6, Simon P Fynn4, Patrick M Heck4, Prashanthan Sanders7, Joseph B Morton8, Jonathan M Kalman8, Peter M Kistler9. 1. Alfred Heart Centre, Alfred Hospital, Melbourne, VIC, Australia Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia. 2. Alfred Heart Centre, Alfred Hospital, Melbourne, VIC, Australia Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia. 3. Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia. 4. Papworth Hospital, Cambridge, UK. 5. Waikato Hospital, Hamilton, New Zealand. 6. Auckland City Hospital, Auckland, New Zealand. 7. Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia. 8. Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia Melbourne Private Hospital, Parkville, VIC, Australia. 9. Alfred Heart Centre, Alfred Hospital, Melbourne, VIC, Australia Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia Department of Medicine, University of Melbourne, Parkville, VIC, Australia Melbourne Private Hospital, Parkville, VIC, Australia Avenue Private Hospital, Windsor, VIC, Australia peter.kistler@bakeridi.edu.au.
Abstract
AIMS: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF). The intervenous ridge (IVR) may be incorporated into ablation strategies to achieve PVI; however, randomized trials are lacking. We performed a randomized multi-centre international study to compare the outcomes of (i) circumferential antral PVI (CPVI) alone (minimal) vs. (ii) CPVI with IVR ablation to achieve individual PVI (maximal). METHODS AND RESULTS: Two hundred and thirty-four patients with paroxysmal AF underwentCPVI and were randomized to a minimal or maximal ablation strategy. The primary outcome of recurrent atrial arrhythmia was assessed with 7-day Holter monitoring at 6 and 12 months. PVI was achieved in all patients. Radiofrequency ablation time was longer in the maximal group (46.6 ± 14.6 vs. 41.5 ± 13.1 min; P < 0.01), with no significant differences in procedural or fluoroscopy times. At mean follow-up of 17 ± 8 months, there was no difference in freedom from AF after a single procedure between a minimal (70%) and maximal ablation strategy (62%; P = 0.25). In the minimal group, ablation was required on the IVR to achieve electrical isolation in 44%, and was associated with a significant reduction in freedom from AF (57%) compared with the minimal group without IVR ablation (80%; P < 0.01). CONCLUSION: There was no statistically significant difference in freedom from AF between a minimal and maximal ablation strategy. Despite attempts to achieve PVI with antral ablation, IVR ablation is commonly required. Patients in whom antral isolation can be achieved without IVR ablation have higher long-term freedom from AF (the Minimax study; ACTRN12610000863033). Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF). The intervenous ridge (IVR) may be incorporated into ablation strategies to achieve PVI; however, randomized trials are lacking. We performed a randomized multi-centre international study to compare the outcomes of (i) circumferential antral PVI (CPVI) alone (minimal) vs. (ii) CPVI with IVR ablation to achieve individual PVI (maximal). METHODS AND RESULTS: Two hundred and thirty-four patients with paroxysmal AF underwent CPVI and were randomized to a minimal or maximal ablation strategy. The primary outcome of recurrent atrial arrhythmia was assessed with 7-day Holter monitoring at 6 and 12 months. PVI was achieved in all patients. Radiofrequency ablation time was longer in the maximal group (46.6 ± 14.6 vs. 41.5 ± 13.1 min; P < 0.01), with no significant differences in procedural or fluoroscopy times. At mean follow-up of 17 ± 8 months, there was no difference in freedom from AF after a single procedure between a minimal (70%) and maximal ablation strategy (62%; P = 0.25). In the minimal group, ablation was required on the IVR to achieve electrical isolation in 44%, and was associated with a significant reduction in freedom from AF (57%) compared with the minimal group without IVR ablation (80%; P < 0.01). CONCLUSION: There was no statistically significant difference in freedom from AF between a minimal and maximal ablation strategy. Despite attempts to achieve PVI with antral ablation, IVR ablation is commonly required. Patients in whom antral isolation can be achieved without IVR ablation have higher long-term freedom from AF (the Minimax study; ACTRN12610000863033). Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Zsuzsanna Kis; Taulant Muka; Oscar H Franco; Wichor M Bramer; Lennart J De Vries; Attila Kardos; Tamas Szili-Torok Journal: Curr Cardiol Rev Date: 2017
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Authors: Emmanouil Charitakis; Silvia Metelli; Lars O Karlsson; Antonios P Antoniadis; Ioan Liuba; Henrik Almroth; Anders Hassel Jönsson; Jonas Schwieler; Skevos Sideris; Dimitrios Tsartsalis; Elena Dragioti; Nikolaos Fragakis; Anna Chaimani Journal: Diagnostics (Basel) Date: 2022-02-09