Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study.
BACKGROUND
Pulmonary vein (PV) isolation is a promising new treatment for atrial fibrillation (AF). We hypothesized that isolation of large areas around both ipsilateral PVs with verification of conduction block is more effective than the isolation of each individual PV.


RESULTS
A total of 110 patients, 67 with paroxysmal AF and 43 with persistent AF, were randomly assigned to undergo either isolation of each individual PV or isolation of large areas around both ipsilateral PVs. The isolation of each individual PV was an electrophysiologically guided, ostial segmental ablation with a 64-pole basket catheter or a 20-pole circular mapping catheter (group I). Isolation of large areas was performed around the 2 ipsilateral veins with a nonfluoroscopic navigation system and a circular 20-pole mapping catheter for verification of conduction block (group II). In both groups, an irrigated-tip ablation catheter (25 to 35 W) was used to achieve complete isolation. Procedure and ablation times were longer in group II, whereas fluoroscopic time was significantly shorter (P < or = 0.001). After a follow-up period of 15+/-4 months, 27 patients in group I (49%) and 37 patients in group II (67%) remained free of symptoms of AF and had no AF or atrial flutter during repetitive Holter monitoring without antiarrhythmic drug treatment after a single procedure (P < or = 0.05).


CONCLUSIONS
The rate of success was significantly higher and fluoroscopy times were significantly lower in the group with large isolation areas around both ipsilateral PVs than in those who underwent individual PV isolation.
Arentz
Thomas
T
Herz-Zentrum, Abteilung Rhythmologie, Südring 15, 79189 Bad Krozingen, Germany. thomas.arentz@herzzentrum.de
Weber
Reinhold
R
Bürkle
Gerd
G
Herrera
Claudia
C
Blum
Thomas
T
Stockinger
Jochem
J
Minners
Jan
J
Neumann
Franz Josef
FJ
Kalusche
Dietrich
D
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D003326:Coronary Circulation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin