Atrial fibrillation ablation strategies for paroxysmal patients: randomized comparison between different techniques.
BACKGROUND
Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF.


RESULTS
One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAEs group (P<0.001) after a single procedure and with antiarrhythmic drugs.


CONCLUSIONS
No difference in terms of success rate was seen between PVAI alone and PVAI associated with defragmentation. CFAEs ablation alone had the smallest impact on AF recurrences at 1-year follow-up. These results suggest that antral isolation is sufficient to treat most patients with paroxysmal AF.
Di Biase
Luigi
L
Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, Texas 78705, USA.
Elayi
Claude S
CS
Fahmy
Tamer S
TS
Martin
David O
DO
Ching
Chi Keong
CK
Barrett
Conor
C
Bai
Rong
R
Patel
Dimpi
D
Khaykin
Yaariv
Y
Hongo
Richard
R
Hao
Steven
S
Beheiry
Salwa
S
Pelargonio
Gemma
G
Dello Russo
Antonio
A
Casella
Michela
M
Santarelli
Pietro
P
Potenza
Domenico
D
Fanelli
Raffaele
R
Massaro
Raimondo
R
Wang
Paul
P
Al-Ahmad
Amin
A
Arruda
Mauricio
M
Themistoclakis
Sakis
S
Bonso
Aldo
A
Rossillo
Antonio
A
Raviele
Antonio
A
Schweikert
Robert A
RA
Burkhardt
David J
DJ
Natale
Andrea
A
D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery; D013612:Tachycardia, Ectopic Atrial / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome