title: Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial.
abstract: BACKGROUND
  Catheter ablation (CA) and minimally invasive surgical ablation (SA) have become accepted therapy for antiarrhythmic drug-refractory atrial fibrillation. This study describes the first randomized clinical trial comparing their efficacy and safety during a 12-month follow-up.
  
  
  RESULTS
  One hundred twenty-four patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension (42 patients, 33%) or failed prior CA (82 patients, 67%) were randomized to CA (63 patients) or SA (61 patients). CA consisted of linear antral pulmonary vein isolation and optional additional lines. SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation, and left atrial appendage excision with optional additional lines. Follow-up at 6 and 12 months was performed by ECG and 7-day Holter recording. The primary end point, freedom from left atrial arrhythmia >30 seconds without antiarrhythmic drugs after 12 months, was 36.5% for CA and 65.6% for SA (P=0.0022). There was no difference in effect for subgroups, which was consistent at both sites. The primary safety end point of significant adverse events during the 12-month follow-up was significantly higher for SA than for CA (n=21 [34.4%] versus n=10 [15.9%]; P=0.027), driven mainly by procedural complications such as pneumothorax, major bleeding, and the need for pacemaker. In the CA group, 1 patient died at 1 month of subarachnoid hemorrhage.
  
  
  CONCLUSIONS
  In atrial fibrillation patients with dilated left atrium and hypertension or failed prior atrial fibrillation CA, SA is superior to CA in achieving freedom from left atrial arrhythmias after 12 months of follow-up, although the procedural adverse event rate is significantly higher for SA than for CA.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique identifier: NCT00662701.
authors.affiliation: Cardiology Department, St. Antonius Hospital, PO 2500, Nieuwegein, Netherlands. l.boersma@antoniusziekenhuis.nl
authors.forename: Lucas V A
authors.initials: LV
authors.lastname: Boersma
authors.forename: Manuel
authors.initials: M
authors.lastname: Castella
authors.forename: Wimjan
authors.initials: W
authors.lastname: van Boven
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Alaaddin
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Mercedes
authors.initials: M
authors.lastname: Nadal
authors.forename: Elena
authors.initials: E
authors.lastname: Sandoval
authors.forename: Naiara
authors.initials: N
authors.lastname: Calvo
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Johannes
authors.initials: J
authors.lastname: Kelder
authors.forename: Maurits
authors.initials: M
authors.lastname: Wijffels
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome