Results from a single-blind, randomized study comparing the impact of different ablation approaches on long-term procedure outcome in coexistent atrial fibrillation and flutter (approval)

Sanghamitra Mohanty, Prasant Mohanty, Luigi Di Biase, Rong Bai, Pasquale Santangeli, Michela Casella, Antonio Dello Russo, Claudio Tondo, Sakis Themistoclakis, Antonio Raviele, Antonio Rossillo, Andrea Corrado, Gemma Pelargonio, Giovanni Forleo, Andrea Natale

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

BACKGROUND-: This study examined the impact of different ablation strategies on atrial fibrillation (AF) recurrence and quality of life in coexistent AF and atrial flutter (AFL). METHODS AND RESULTS-: Three-hundred sixty enrolled patients with documented AF and AFL were blinded and randomized to group 1, AF±AFL ablation (n=182), or group 2, AFL ablation only (n=178). AF recurrence was evaluated with event recording and 7-day Holter at 3, 6, 9, and 12-month follow-ups. Quality of life was assessed at baseline and at the 12-month follow-up with 4 questionnaires: the Medical Outcome Study Short Form, the Hospital Anxiety and Depression Score, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Of the 182 patients in group 1, 58 (age, 63±8 years; 78% male; left ventricular ejection fraction, 59±8%) had AF+AFL ablation and 124 (age, 61±11 years; 72% male; left ventricular ejection fraction, 59±7%) had AF ablation only. In group 2 (age, 62±9 years; 76% male; left ventricular ejection fraction, 58±10%), only AFL was ablated by achieving bidirectional isthmus conduction block. Baseline characteristics were not different across groups. At 21±9 months of follow-up, 117 in group 1 (64%) and 34 in group 2 (19%) were arrhythmia free (P<0.001). In group 1, scores on most quality-of-life subscales showed significant improvement at follow-up, whereas group 2 patients derived relatively minor benefit. CONCLUSIONS-: In coexistent AF and AFL, lower recurrence rate and better quality of life are associated with AF ablation only or AF+AFL ablation than with lone AFL ablation. Furthermore, quality of life directly correlates with freedom from arrhythmia, as shown in this study for the first time in patients blinded to the procedure. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrial.gov/. Unique identifier: NCT01439386.

Original languageEnglish (US)
Pages (from-to)1853-1860
Number of pages8
JournalCirculation
Volume127
Issue number18
DOIs
StatePublished - May 7 2013

Keywords

  • Recurrence
  • ablation techniques
  • atrial fibrillation
  • atrial flutter
  • pulmonary veins
  • quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Mohanty, S., Mohanty, P., Di Biase, L., Bai, R., Santangeli, P., Casella, M., Russo, A. D., Tondo, C., Themistoclakis, S., Raviele, A., Rossillo, A., Corrado, A., Pelargonio, G., Forleo, G., & Natale, A. (2013). Results from a single-blind, randomized study comparing the impact of different ablation approaches on long-term procedure outcome in coexistent atrial fibrillation and flutter (approval). Circulation, 127(18), 1853-1860. https://doi.org/10.1161/CIRCULATIONAHA.113.001855