Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve-inferior vena cava isthmus? Results of a multicentre randomised controlled trial.
OBJECTIVE
To see if strategy of ablating the tricuspid annulus-inferior vena cava isthmus (TV-IVC) is superior to electrical cardioversion to prevent recurrences in patients with coarse atrial fibrillation.


METHODS
Prospective randomised controlled multicentre study.


METHODS
Four tertiary referral hospitals in the UK.


METHODS
57 patients with persistent coarse atrial fibrillation (irregular P waves > or =0.15 mV in > or =1 ECG lead).


METHODS
Patients were randomised to receive external cardioversion (group A, n = 30) or TV-IVC ablation +/- DC cardioversion (group B, n = 27).


METHODS
Cardiac rhythm, scores on quality of life and symptom questionnaires were assessed at 4, 16 and 52 weeks after the procedure.


RESULTS
20 (67%) patients in group A and 19 (70%) patients in group B were in sinus rhythm immediately after their index procedure. At 4, 16 and 52 weeks, the number of patients in sinus rhythm were 5, 3 and 2 in group A and 3, 3 and 1 in group B (p = NS). The quality of life and symptom questionnaire scores were similar in the two groups at each period of follow-up, although they were significantly better for sinus rhythm than for atrial fibrillation at each follow-up visit.


CONCLUSIONS
As a first-line strategy, TV-IVC ablation offers no advantages over direct current cardioversion for the management of coarse atrial fibrillation.
Gupta
Dhiraj
D
St Bartholomew's Hospital, West Smithfield, London, UK.
Earley
Mark J
MJ
Haywood
Guy A
GA
Richmond
Laura
L
Fitzgerald
Melissa
M
Kojodjojo
Pipin
P
Sporton
Simon C
SC
Peters
Nicholas S
NS
Broadhurst
Paul
P
Schilling
Richard J
RJ
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D014261:Tricuspid Valve / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*