Massimiliano Faustino1, Carmine Pizzi2, Tullio Agricola3, Borejda Xhyheri4, Grazia Maria Costa4, Maria Elena Flacco5, Lorenzo Capasso6, Giancarlo Cicolini7, Enrico Di Girolamo8, Luigi Leonzio8, Lamberto Manzoli9. 1. Cardiology Department, Private Hospital "L. Pierangeli," Pescara, Italy; Electrophysiology Operating Unit, Cardiovascular Department, "Spirito Santo" Hospital, ASL Pescara, Pescara, Italy. 2. Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy. Electronic address: carmine.pizzi@unibo.it. 3. Electrophysiology Operating Unit, Cardiovascular Department, "Spirito Santo" Hospital, ASL Pescara, Pescara, Italy. 4. Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy. 5. Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; Local Health Unit of Pescara, Pescara, Italy. 6. Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; EMISAC, CeSi Biotech, Chieti, Italy. 7. Nursing Department, ASL Lanciano-Vasto-Chieti, Chieti, Italy. 8. Cardiology Department, ASL Lanciano-Vasto-Chieti, Chieti, Italy. 9. Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; EMISAC, CeSi Biotech, Chieti, Italy; Regional Healthcare Agency of Abruzzo, Pescara, Italy; Local Health Unit of Pescara, Pescara, Italy.
Abstract
BACKGROUND:Pulmonary vein isolation (PVI) is a central procedure for the treatment of paroxysmal atrial fibrillation (PAF). However, in patients with PAF and structural atrial disease, PVI may fail and cause progressive atrial remodeling, often leading to persistent/permanent atrial fibrillation. OBJECTIVE: We performed a prospective, single-blind, 2-center randomized controlled trial to compare the efficacy of PVI alone with that of PVI plus stepwise ablation in achieving sinus rhythm and nonatrial arrhythmia inducibility in patients with PAF refractory to antiarrhythmic therapy. METHODS: Patients were randomized to perform a first catheter ablation procedure either through PVI alone or through PVI plus substrate modification in stepwise ablation. Data were recorded at 3, 6, and 12 months after both ablation procedures. Patients who experienced atrial fibrillation/atrial tachycardia (AF/AT) recurrence were encouraged to undergo repeat ablation using the technique of the first ablation procedure. RESULTS:A total of 150 patients were enrolled (mean age 62.8 ± 8.7 years; 92 (61.3%) men; 104 (69.3%) hypertensive; AF mean duration 10.7 months), with 75 patients in each group. After 12 months of the first procedure, patients who were converted to sinus rhythm using stepwise ablation showed a significantly lower rate of AF/AT recurrence (26.7%) than did those who were treated using PVI alone (46.7%; P < .001). Similar results were observed in the 52 patients who underwent a second catheter ablation procedure. After adjusting for several potential confounders, the hazard ratio of 12-month AF/AT recurrence after the first ablation procedure was 0.53 (95% confidence interval 0.30-0.91) for those treated using stepwise ablation. CONCLUSION: In addition to PVI, stepwise ablation achieving sinus rhythm and nonatrial arrhythmia inducibility has relevantly improved the clinical outcome of the PAF control strategy.
RCT Entities:
BACKGROUND: Pulmonary vein isolation (PVI) is a central procedure for the treatment of paroxysmal atrial fibrillation (PAF). However, in patients with PAF and structural atrial disease, PVI may fail and cause progressive atrial remodeling, often leading to persistent/permanent atrial fibrillation. OBJECTIVE: We performed a prospective, single-blind, 2-center randomized controlled trial to compare the efficacy of PVI alone with that of PVI plus stepwise ablation in achieving sinus rhythm and nonatrial arrhythmia inducibility in patients with PAF refractory to antiarrhythmic therapy. METHODS:Patients were randomized to perform a first catheter ablation procedure either through PVI alone or through PVI plus substrate modification in stepwise ablation. Data were recorded at 3, 6, and 12 months after both ablation procedures. Patients who experienced atrial fibrillation/atrial tachycardia (AF/AT) recurrence were encouraged to undergo repeat ablation using the technique of the first ablation procedure. RESULTS: A total of 150 patients were enrolled (mean age 62.8 ± 8.7 years; 92 (61.3%) men; 104 (69.3%) hypertensive; AF mean duration 10.7 months), with 75 patients in each group. After 12 months of the first procedure, patients who were converted to sinus rhythm using stepwise ablation showed a significantly lower rate of AF/AT recurrence (26.7%) than did those who were treated using PVI alone (46.7%; P < .001). Similar results were observed in the 52 patients who underwent a second catheter ablation procedure. After adjusting for several potential confounders, the hazard ratio of 12-month AF/AT recurrence after the first ablation procedure was 0.53 (95% confidence interval 0.30-0.91) for those treated using stepwise ablation. CONCLUSION: In addition to PVI, stepwise ablation achieving sinus rhythm and nonatrial arrhythmia inducibility has relevantly improved the clinical outcome of the PAF control strategy.
Authors: Emmanouil Charitakis; Silvia Metelli; Lars O Karlsson; Antonios P Antoniadis; Konstantinos D Rizas; Ioan Liuba; Henrik Almroth; Anders Hassel Jönsson; Jonas Schwieler; Dimitrios Tsartsalis; Skevos Sideris; Elena Dragioti; Nikolaos Fragakis; Anna Chaimani Journal: BMC Med Date: 2022-05-31 Impact factor: 11.150
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