INTRODUCTION: PVI is a well-established therapy for patients with drug refractory atrial fibrillation (AF). However, it remains unclear whether prophylactic cavotricuspid isthmus (CTI) ablation at the time of PVI improves long-term freedom from AF. OBJECTIVE: To compare the outcomes of patients who underwent PVI alone vs. PVI + prophylactic CTI ablation. METHODS: Propensity score (PS) matching analysis based on a registry dataset of 1931 consecutive patients who underwent a first AF catheter ablation. After excluding those with documented/inducible atrial flutter (n = 233), 1698 individuals were available for matching. Following adjustment for age, gender, body mass index (BMI), hypertension, smoking, diabetes, LA volume, type of AF, and type of navigation (magnetic vs. manual), PS matched 411 patients who underwent PVI + CTI ablation with 411 receiving PVI alone. RESULTS: PS analysis yielded a study population of 822 matched patients (58 ± 11 years, 69% males, 64% with paroxysmal AF). Over a median 2 years follow-up period there were 278 AF recurrences (34%). Survival free of AF (Log rank p = .965) and annual relapse rates were similar in the two groups - 10.9%/year vs 10.1%/year (PVI vs PVI + CTI, respectively, p = .97). CTI ablation remained unassociated with AF-free survival (HR 1.09, 95%CI: 0.84-1.41, p = .54) after Cox regression adjustment for age, sex, type of AF, LA volume, hypertension, diabetes, BMI and center. Female gender, current smoking, indexed LA volume and non-paroxysmal AF were identified as independent predictors of relapse after matching. CONCLUSIONS: Prophylactic CTI ablation at the time of a first PVI does not seem to improve long-term freedom from AF.
INTRODUCTION:PVI is a well-established therapy for patients with drug refractory atrial fibrillation (AF). However, it remains unclear whether prophylactic cavotricuspid isthmus (CTI) ablation at the time of PVI improves long-term freedom from AF. OBJECTIVE: To compare the outcomes of patients who underwent PVI alone vs. PVI + prophylactic CTI ablation. METHODS: Propensity score (PS) matching analysis based on a registry dataset of 1931 consecutive patients who underwent a first AF catheter ablation. After excluding those with documented/inducible atrial flutter (n = 233), 1698 individuals were available for matching. Following adjustment for age, gender, body mass index (BMI), hypertension, smoking, diabetes, LA volume, type of AF, and type of navigation (magnetic vs. manual), PS matched 411 patients who underwent PVI + CTI ablation with 411 receiving PVI alone. RESULTS: PS analysis yielded a study population of 822 matched patients (58 ± 11 years, 69% males, 64% with paroxysmal AF). Over a median 2 years follow-up period there were 278 AF recurrences (34%). Survival free of AF (Log rank p = .965) and annual relapse rates were similar in the two groups - 10.9%/year vs 10.1%/year (PVI vs PVI + CTI, respectively, p = .97). CTI ablation remained unassociated with AF-free survival (HR 1.09, 95%CI: 0.84-1.41, p = .54) after Cox regression adjustment for age, sex, type of AF, LA volume, hypertension, diabetes, BMI and center. Female gender, current smoking, indexed LA volume and non-paroxysmal AF were identified as independent predictors of relapse after matching. CONCLUSIONS: Prophylactic CTI ablation at the time of a first PVI does not seem to improve long-term freedom from AF.
Authors: Jayson R Baman; Rachel M Kaplan; Celso L Diaz; Graham Peigh; Aakash A Bavishi; Amar Trivedi; Jeremiah Wasserlauf; Alexandru B Chicos; Rishi Arora; Susan Kim; Albert Lin; Nishant Verma; Bradley P Knight; Rod S Passman Journal: J Interv Card Electrophysiol Date: 2019-05-17 Impact factor: 1.900
Authors: Ivan Zeljkovic; Sven Knecht; Florian Spies; Tobias Reichlin; Stefan Osswald; Michael Kühne; Christian Sticherling Journal: J Interv Card Electrophysiol Date: 2020-01-07 Impact factor: 1.900
Authors: Ellen Hoffmann; Florian Straube; Karl Wegscheider; Malte Kuniss; Dietrich Andresen; Li-Qun Wu; Jürgen Tebbenjohanns; Georg Noelker; Roland Richard Tilz; Julian Kyoung Ryul Chun; Andreas Franke; Christoph Stellbrink; Arcadi Garcia-Alberola; Uwe Dorwarth; Andreas Metzner; Taoufik Ouarrak; Johannes Brachmann; Karl-Heinz Kuck; Jochen Senges Journal: Europace Date: 2019-09-01 Impact factor: 5.214