title: Atrial fibrillation ablation strategies for paroxysmal patients: randomized comparison between different techniques.
abstract: 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.
authors.affiliation: Texas Cardiac Arrhythmia Institute at St David's Medical Center, Austin, Texas 78705, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.forename: Tamer S
authors.initials: TS
authors.lastname: Fahmy
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Chi Keong
authors.initials: CK
authors.lastname: Ching
authors.forename: Conor
authors.initials: C
authors.lastname: Barrett
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Pietro
authors.initials: P
authors.lastname: Santarelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Potenza
authors.forename: Raffaele
authors.initials: R
authors.lastname: Fanelli
authors.forename: Raimondo
authors.initials: R
authors.lastname: Massaro
authors.forename: Paul
authors.initials: P
authors.lastname: Wang
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.forename: Mauricio
authors.initials: M
authors.lastname: Arruda
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonso
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossillo
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: David J
authors.initials: DJ
authors.lastname: Burkhardt
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: 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