TY - JOUR
T1 - Ablation for longstanding permanent atrial fibrillation
T2 - Results from a randomized study comparing three different strategies
AU - Elayi, Claude S.
AU - Verma, Atul
AU - Di Biase, Luigi
AU - Ching, Chi Keong
AU - Patel, Dimpi
AU - Barrett, Conor
AU - Martin, David
AU - Rong, Bai
AU - Fahmy, Tamer S.
AU - Khaykin, Yaariv
AU - Hongo, Richard
AU - Hao, Steven
AU - Pelargonio, Gemma
AU - Dello Russo, Antonio
AU - Casella, Michela
AU - Santarelli, Pietro
AU - Potenza, Domenico
AU - Fanelli, Raffaele
AU - Massaro, Raimondo
AU - Arruda, Mauricio
AU - Schweikert, Robert A.
AU - Natale, Andrea
PY - 2008/12
Y1 - 2008/12
N2 - Background: This prospective multicenter randomized study aimed to compare the efficacy of 3 common ablation methods used for longstanding permanent atrial fibrillation (AF). Methods: A total of 144 patients with longstanding permanent AF (median duration 28 months) were randomly assigned to circumferential pulmonary vein ablation (CPVA, group 1, n = 47), to pulmonary vein antrum isolation (PVAI, group 2, n = 48) or to a hybrid strategy combining ablation of complex fractionated or rapid atrial electrograms (CFAE) in both atria followed by a pulmonary vein antrum isolation (CFAE + PVAI, group 3, n = 49). Results: Scarring in the left atrium and structural heart disease/hypertension were present in most patients (65%). After a mean follow-up of 16 months, 11% of patients in group 1, 40% of patients in group 2 and 61% of patients in group 3 were in sinus rhythm after one procedure and with no antiarrhythmic drugs (P < .001). Sinus rhythm maintenance would increase respectively to 28% (group 1), 83% (group 2), and 94% (group 3) after 2 procedures and with antiarrhythmic drugs (AADs, P < .001). The AF terminated during ablation, either by conversion to sinus rhythm or organization into an atrial tachyarrhythmia, in 13% of patients (group 1), 44% (group 2), and 74% (group 3) respectively. CFAE alone, performed as the first step of the ablation in group 3, organized AF in only 1 patient. Conclusion: In this study, the hybrid AF ablation strategy including antrum isolation and CFAE ablation had the highest likelihood of maintaining sinus rhythm in patients with longstanding permanent AF. Electrical isolation of the PVs, although inadequate if performed alone, is relevant to achieve long-term sinus rhythm maintenance after ablation. Bi-atrial CFAE ablation had a minimal impact on AF termination during ablation.
AB - Background: This prospective multicenter randomized study aimed to compare the efficacy of 3 common ablation methods used for longstanding permanent atrial fibrillation (AF). Methods: A total of 144 patients with longstanding permanent AF (median duration 28 months) were randomly assigned to circumferential pulmonary vein ablation (CPVA, group 1, n = 47), to pulmonary vein antrum isolation (PVAI, group 2, n = 48) or to a hybrid strategy combining ablation of complex fractionated or rapid atrial electrograms (CFAE) in both atria followed by a pulmonary vein antrum isolation (CFAE + PVAI, group 3, n = 49). Results: Scarring in the left atrium and structural heart disease/hypertension were present in most patients (65%). After a mean follow-up of 16 months, 11% of patients in group 1, 40% of patients in group 2 and 61% of patients in group 3 were in sinus rhythm after one procedure and with no antiarrhythmic drugs (P < .001). Sinus rhythm maintenance would increase respectively to 28% (group 1), 83% (group 2), and 94% (group 3) after 2 procedures and with antiarrhythmic drugs (AADs, P < .001). The AF terminated during ablation, either by conversion to sinus rhythm or organization into an atrial tachyarrhythmia, in 13% of patients (group 1), 44% (group 2), and 74% (group 3) respectively. CFAE alone, performed as the first step of the ablation in group 3, organized AF in only 1 patient. Conclusion: In this study, the hybrid AF ablation strategy including antrum isolation and CFAE ablation had the highest likelihood of maintaining sinus rhythm in patients with longstanding permanent AF. Electrical isolation of the PVs, although inadequate if performed alone, is relevant to achieve long-term sinus rhythm maintenance after ablation. Bi-atrial CFAE ablation had a minimal impact on AF termination during ablation.
KW - Ablation
KW - Atrial fibrillation
KW - Chronic atrial fibrillation
KW - Permanent atrial fibrillation
KW - Pulmonary vein antrum isolation
KW - Pulmonary veins
KW - Radiofrequency
KW - Randomized study
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U2 - 10.1016/j.hrthm.2008.09.016
DO - 10.1016/j.hrthm.2008.09.016
M3 - Article
C2 - 19084800
AN - SCOPUS:59749099147
SN - 1547-5271
VL - 5
SP - 1658
EP - 1664
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -