Ablation for longstanding permanent atrial fibrillation: Results from a randomized study comparing three different strategies

Claude S. Elayi, Atul Verma, Luigi Di Biase, Chi Keong Ching, Dimpi Patel, Conor Barrett, David Martin, Bai Rong, Tamer S. Fahmy, Yaariv Khaykin, Richard Hongo, Steven Hao, Gemma Pelargonio, Antonio Dello Russo, Michela Casella, Pietro Santarelli, Domenico Potenza, Raffaele Fanelli, Raimondo Massaro, Mauricio ArrudaRobert A. Schweikert, Andrea Natale

Research output: Contribution to journalArticle

253 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1658-1664
Number of pages7
JournalHeart Rhythm
Volume5
Issue number12
DOIs
StatePublished - Dec 2008
Externally publishedYes

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Atrial Fibrillation
Cardiac Electrophysiologic Techniques
Pulmonary Veins
Anti-Arrhythmia Agents
Maintenance
Heart Atria
Tachycardia
Multicenter Studies
Cicatrix
Heart Diseases
Hypertension

Keywords

  • Ablation
  • Atrial fibrillation
  • Chronic atrial fibrillation
  • Permanent atrial fibrillation
  • Pulmonary vein antrum isolation
  • Pulmonary veins
  • Radiofrequency
  • Randomized study

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ablation for longstanding permanent atrial fibrillation : Results from a randomized study comparing three different strategies. / Elayi, Claude S.; Verma, Atul; Di Biase, Luigi; Ching, Chi Keong; Patel, Dimpi; Barrett, Conor; Martin, David; Rong, Bai; Fahmy, Tamer S.; Khaykin, Yaariv; Hongo, Richard; Hao, Steven; Pelargonio, Gemma; Dello Russo, Antonio; Casella, Michela; Santarelli, Pietro; Potenza, Domenico; Fanelli, Raffaele; Massaro, Raimondo; Arruda, Mauricio; Schweikert, Robert A.; Natale, Andrea.

In: Heart Rhythm, Vol. 5, No. 12, 12.2008, p. 1658-1664.

Research output: Contribution to journalArticle

Elayi, CS, Verma, A, Di Biase, L, Ching, CK, Patel, D, Barrett, C, Martin, D, Rong, B, Fahmy, TS, Khaykin, Y, Hongo, R, Hao, S, Pelargonio, G, Dello Russo, A, Casella, M, Santarelli, P, Potenza, D, Fanelli, R, Massaro, R, Arruda, M, Schweikert, RA & Natale, A 2008, 'Ablation for longstanding permanent atrial fibrillation: Results from a randomized study comparing three different strategies', Heart Rhythm, vol. 5, no. 12, pp. 1658-1664. https://doi.org/10.1016/j.hrthm.2008.09.016
Elayi, Claude S. ; Verma, Atul ; Di Biase, Luigi ; Ching, Chi Keong ; Patel, Dimpi ; Barrett, Conor ; Martin, David ; Rong, Bai ; Fahmy, Tamer S. ; Khaykin, Yaariv ; Hongo, Richard ; Hao, Steven ; Pelargonio, Gemma ; Dello Russo, Antonio ; Casella, Michela ; Santarelli, Pietro ; Potenza, Domenico ; Fanelli, Raffaele ; Massaro, Raimondo ; Arruda, Mauricio ; Schweikert, Robert A. ; Natale, Andrea. / Ablation for longstanding permanent atrial fibrillation : Results from a randomized study comparing three different strategies. In: Heart Rhythm. 2008 ; Vol. 5, No. 12. pp. 1658-1664.
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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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