Kwang-No Lee1, Seung-Young Roh1, Yong-Soo Baek1, Hee-Soon Park1, Jinhee Ahn1, Dong-Hyeok Kim1, Dae In Lee1, Jaemin Shim1, Jong-Il Choi1, Sang-Weon Park1, Young-Hoon Kim2. 1. From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.). 2. From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.). yhkmd@unitel.co.kr.
Abstract
BACKGROUND:Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. METHODS AND RESULTS: A total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. CONCLUSIONS: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.
RCT Entities:
BACKGROUND: Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. METHODS AND RESULTS: A total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. CONCLUSIONS: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.
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
Authors: Yun Gi Kim; Ha Young Choi; Jaemin Shim; Kyongjin Min; Yun Young Choi; Jong-Il Choi; Young-Hoon Kim Journal: Korean Circ J Date: 2021-12-21 Impact factor: 3.243