Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach.
BACKGROUND
Circumferential pulmonary vein ablation (CPVA) is effective in curing atrial fibrillation (AF), but new-onset left atrial tachycardia (AT) is a potential complication. We evaluated whether a modified CPVA approach including additional ablation lines on posterior wall and the mitral isthmus would reduce the incidence of AT after PV ablation.


RESULTS
A total of 560 patients (291 men, 52%; age, 56.5+/-7.3 years) entered the study; 280 were randomized to CPVA alone (group 1) and 280 to modified CPVA (group 2). The primary end point was freedom from AT after the procedure. In group 1, 28 patients (10%) experienced new-onset AT, and 41 (14.3%) experienced recurrent AF. In group 2, 11 patients (3.9%) experienced AT, and 36 (12.9%) had recurrent AF. Group 1 was more likely to experience AT than group 2 (P=0.005). Freedom from AF after ablation was similar in both groups (P=0.57). Among those in group 1, gap-related macroreentrant AT was documented in 23 of the 28 patients (82%), and focal AT was found in 5 (18%). In group 2, gap-related macroreentrant AT was found in 8 of the 11 patients (73%), and focal AT was seen in 3 (27%). Two patients in group 1 and 1 patient in group 2 had both AT and AF. The strongest predictor of AT was the presence of gaps (P<0.001).


CONCLUSIONS
Modified CPVA is as effective as CPVA in preventing AF but is associated with a lower risk of developing incessant AT.
Pappone
Carlo
C
Department of Cardiology, Electrophysiology and Cardiac Pacing Unit, San Raffaele University Hospital, Milan, Italy. carlo.pappone@hsr.it
Manguso
Francesco
F
Vicedomini
Gabriele
G
Gugliotta
Filippo
F
Santinelli
Ornella
O
Ferro
Amedeo
A
Gulletta
Simone
S
Sala
Simone
S
Sora
Nicoleta
N
Paglino
Gabriele
G
Augello
Giuseppe
G
Agricola
Eustachio
E
Zangrillo
Alberto
A
Alfieri
Ottavio
O
Santinelli
Vincenzo
V
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016037:Single-Blind Method; D013612:Tachycardia, Ectopic Atrial / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome