Single procedure efficacy of isolating all versus arrhythmogenic pulmonary veins on long-term control of atrial fibrillation: a prospective randomized study.
BACKGROUND
Current atrial fibrillation (AF) ablation involves isolation of all pulmonary veins (PVs) with or without additional linear lesions. However, whether such extensive ablation is necessary is unclear.


OBJECTIVE
The purpose of this study was to assess the efficacy of different ablation strategies on long-term AF control.


METHODS
We prospectively randomized patients to undergo isolation of all versus arrhythmogenic PVs (identified by standardized stimulation protocol). PV isolation was guided by circular mapping catheter. The endpoint was entry/exit block persisting for > or = 20 minutes. Patients were evaluated at three clinic visits (at 6 weeks, 6 months, and 1 year) and multiple transtelephonic monitoring periods. Antiarrhythmic drugs were discontinued at 6 weeks. Primary study endpoint was long-term AF control (freedom or >90% reduction in AF burden off or on previously ineffective antiarrhythmic drugs at 1 year after a single ablation procedure).


RESULTS
Over a 20-month period, 105 patients (76 men and 29 women, age 57 +/- 9 years; paroxysmal AF = 77) were randomized, and 103 patients completed 1-year follow-up (51 patients in all-PV arm, 52 patients in arrhythmogenic PV arm). The primary endpoint was achieved in 75 (73%) patients and was similar in patients randomized to all-PV arm versus arrhythmogenic PV arm [38 (75%) patients vs 37 (71%) patients, respectively; odds ratio 1.18, 95% confidence interval 0.50, 2.83, P = .70]. Secondary study endpoints, including freedom from AF off antiarrhythmic drugs, total procedure/fluoroscopy times, and occurrence of serious adverse events, were not different between the two groups.


CONCLUSIONS
In a randomized comparison, isolation of arrhythmogenic veins was as efficacious as empiric isolation of all veins in achieving long-term AF control.
Dixit
Sanjay
S
Cardiovascular Division, Hospital of The University of Pennsylvania and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Sanjay.Dixit@uphs.upenn.edu
Gerstenfeld
Edward P
EP
Ratcliffe
Sarah J
SJ
Cooper
Joshua M
JM
Russo
Andrea M
AM
Kimmel
Stephen E
SE
Callans
David J
DJ
Lin
David
D
Verdino
Ralph J
RJ
Patel
Vickas V
VV
Zado
Erica
E
Marchlinski
Francis E
FE
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome