title: Does additional linear ablation after circumferential pulmonary vein isolation improve clinical outcome in patients with paroxysmal atrial fibrillation? Prospective randomised study.
abstract: OBJECTIVE
  Circumferential pulmonary vein isolation (CPVI) has been considered the cornerstone of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, it is unclear whether linear ablation in addition to CPVI improves clinical outcome.
  
  
  METHODS
  Prospective randomised study to compare the efficacy of CPVI and CPVI with additional linear ablation in patients with paroxysmal AF (PAF).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  This study enrolled 156 patients (male 76.3%, 55.8±11.5 years old (mean±SD)) who underwent RFCA for PAF.
  
  
  METHODS
  CPVI (n=52), CPVI+roof line (CPVI+RL; n=52) and CPVI+RL+posterior inferior line (CPVI+PostBox; n=52).
  
  
  METHODS
  Procedure time, ablation time and clinical outcome.
  
  
  RESULTS
  (1) The CPVI group showed shorter total procedure time (180.4±39.5 min vs 189.6±29.0 min and 201.7±51.7 min, respectively (mean±SD); p=0.035) and ablation time (4085.5±1384.1 s vs 5253.5±1010.9 s and 5495.0±1316.0 s, respectively; p<0.001) than the CPVI+RL and CPVI+PostBox groups. (2) During 15.6±5.0 months of follow-up, the recurrence rates 3 months after RFCA were 11.5% in CPVI, 21.2% in CPVI+RL and 19.2% in CPVI+PostBox (p=0.440). (3) The achievement rate of CPVI was 100.0%, and bidirectional block rate was 80.8% in CPVI+RL and 59.6% in CPVI+PostBox. The clinical recurrence rates with or without achieving bidirectional block were not significantly different from each other (p=0.386).
  
  
  CONCLUSIONS
  In patients with PAF, linear ablation in addition to CPVI did not improve clinical outcome, regardless of bidirectional block achievement, while it prolonged the total procedure and ablation time.
authors.affiliation: Department of Cardiology, Yonsei University Health System, 250 Seungsanno, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Hee-Sun
authors.initials: HS
authors.lastname: Mun
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.forename: Jaemin
authors.initials: J
authors.lastname: Shim
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Hwang
authors.forename: Jong Youn
authors.initials: JY
authors.lastname: Kim
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome