Atrial fibrillation ablation strategies for paroxysmal patients randomized comparison between different techniques

Claude S. Elayi, Tamer S. Fahmy, David O. Martin, Chi Keong Ching, Conor Barrett, Rong Bai, Dimpi Patel, Yaariv Khaykin, Richard Hongo, Steven Hao, Salwa Beheiry, Gemma Pelargonio, Antonio Dello Russo, Michela Casella, Pietro Santarelli, Domenico Potenza, Raffaele Fanelli, Raimondo Massaro, Paul Wang, Amin Al-Ahmad & 9 others Mauricio Arruda, Sakis Themistoclakis, Aldo Bonso, Antonio Rossillo, Antonio Raviele, Robert A. Schweikert, David J. Burkhardt, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Background-Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF. Methods and Results-One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAEs group (P<0.001) after a single procedure and with antiarrhythmic drugs. Conclusion-No difference in terms of success rate was seen between PVAI alone and PVAI associated with defragmentation. CFAEs ablation alone had the smallest impact on AF recurrences at 1-year follow-up. These results suggest that antral isolation is sufficient to treat most patients with paroxysmal AF. (Circ Arrhythmia Electrophysiol. 2009;2:113-119.)

Original languageEnglish (US)
Pages (from-to)113-119
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume2
Issue number2
DOIs
StatePublished - Apr 2009
Externally publishedYes

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Atrial Fibrillation
Tachycardia
Cardiac Electrophysiologic Techniques
Pulmonary Veins
Electrophysiology
Anti-Arrhythmia Agents
Cardiac Arrhythmias
Recurrence

Keywords

  • Catheter ablation
  • Complex fractionated atrial electrograms or defragmentation
  • Paroxysmal atrial fibrillation
  • Pulmonary vein antrum isolation
  • Radiofrequency
  • Randomized study

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Atrial fibrillation ablation strategies for paroxysmal patients randomized comparison between different techniques. / Elayi, Claude S.; Fahmy, Tamer S.; Martin, David O.; Ching, Chi Keong; Barrett, Conor; Bai, Rong; Patel, Dimpi; Khaykin, Yaariv; Hongo, Richard; Hao, Steven; Beheiry, Salwa; Pelargonio, Gemma; Russo, Antonio Dello; Casella, Michela; Santarelli, Pietro; Potenza, Domenico; Fanelli, Raffaele; Massaro, Raimondo; Wang, Paul; Al-Ahmad, Amin; Arruda, Mauricio; Themistoclakis, Sakis; Bonso, Aldo; Rossillo, Antonio; Raviele, Antonio; Schweikert, Robert A.; Burkhardt, David J.; Natale, Andrea; Di Biase, Luigi.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 2, No. 2, 04.2009, p. 113-119.

Research output: Contribution to journalArticle

Elayi, CS, Fahmy, TS, Martin, DO, Ching, CK, Barrett, C, Bai, R, Patel, D, Khaykin, Y, Hongo, R, Hao, S, Beheiry, S, Pelargonio, G, Russo, AD, Casella, M, Santarelli, P, Potenza, D, Fanelli, R, Massaro, R, Wang, P, Al-Ahmad, A, Arruda, M, Themistoclakis, S, Bonso, A, Rossillo, A, Raviele, A, Schweikert, RA, Burkhardt, DJ, Natale, A & Di Biase, L 2009, 'Atrial fibrillation ablation strategies for paroxysmal patients randomized comparison between different techniques', Circulation: Arrhythmia and Electrophysiology, vol. 2, no. 2, pp. 113-119. https://doi.org/10.1161/CIRCEP.108.798447
Elayi, Claude S. ; Fahmy, Tamer S. ; Martin, David O. ; Ching, Chi Keong ; Barrett, Conor ; Bai, Rong ; Patel, Dimpi ; Khaykin, Yaariv ; Hongo, Richard ; Hao, Steven ; Beheiry, Salwa ; Pelargonio, Gemma ; Russo, Antonio Dello ; Casella, Michela ; Santarelli, Pietro ; Potenza, Domenico ; Fanelli, Raffaele ; Massaro, Raimondo ; Wang, Paul ; Al-Ahmad, Amin ; Arruda, Mauricio ; Themistoclakis, Sakis ; Bonso, Aldo ; Rossillo, Antonio ; Raviele, Antonio ; Schweikert, Robert A. ; Burkhardt, David J. ; Natale, Andrea ; Di Biase, Luigi. / Atrial fibrillation ablation strategies for paroxysmal patients randomized comparison between different techniques. In: Circulation: Arrhythmia and Electrophysiology. 2009 ; Vol. 2, No. 2. pp. 113-119.
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AU - Elayi, Claude S.

AU - Fahmy, Tamer S.

AU - Martin, David O.

AU - Ching, Chi Keong

AU - Barrett, Conor

AU - Bai, Rong

AU - Patel, Dimpi

AU - Khaykin, Yaariv

AU - Hongo, Richard

AU - Hao, Steven

AU - Beheiry, Salwa

AU - Pelargonio, Gemma

AU - Russo, Antonio Dello

AU - Casella, Michela

AU - Santarelli, Pietro

AU - Potenza, Domenico

AU - Fanelli, Raffaele

AU - Massaro, Raimondo

AU - Wang, Paul

AU - Al-Ahmad, Amin

AU - Arruda, Mauricio

AU - Themistoclakis, Sakis

AU - Bonso, Aldo

AU - Rossillo, Antonio

AU - Raviele, Antonio

AU - Schweikert, Robert A.

AU - Burkhardt, David J.

AU - Natale, Andrea

AU - Di Biase, Luigi

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N2 - Background-Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF. Methods and Results-One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAEs group (P<0.001) after a single procedure and with antiarrhythmic drugs. Conclusion-No difference in terms of success rate was seen between PVAI alone and PVAI associated with defragmentation. CFAEs ablation alone had the smallest impact on AF recurrences at 1-year follow-up. These results suggest that antral isolation is sufficient to treat most patients with paroxysmal AF. (Circ Arrhythmia Electrophysiol. 2009;2:113-119.)

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KW - Complex fractionated atrial electrograms or defragmentation

KW - Paroxysmal atrial fibrillation

KW - Pulmonary vein antrum isolation

KW - Radiofrequency

KW - Randomized study

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