A prospective, randomized comparison of modified pulmonary vein isolation versus conventional pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
BACKGROUND
Pulmonary vein isolation (PVI) is the primary ablation therapy in patients with atrial fibrillation (AF). We hypothesized that high dominant frequency (DF) sites (AF nests during sinus rhythm [SR]) adjacent to the PV ostia are associated with the atrial substrate that maintains AF, and PVI incorporating the high-frequency AF nests may have a higher efficacy.


RESULTS
In a prospective and randomized comparison, 126 symptomatic paroxysmal AF patients that underwent PVI were enrolled. We compared the efficacy of a modified PVI (ablation line: 1.0-1.5 cm from the PV ostium with encircling the AF nests [spectral analysis with DF >70 Hz during SR, Group II]) versus the anatomy-guided conventional PVI (Group I). In Group II, the DF value along the PV ostium was lower than 70 Hz after the PVI. The primary endpoint was the freedom from symptomatic atrial arrhythmias after a single procedure. We also followed the autonomic function by a time-domain analysis of the heart rate variability. In both groups, AF nests were observed and electric isolation was successfully obtained in all patients. With a mean duration of 16 ± 6.1 months of follow-up, Group II had a higher single procedure efficacy without drugs (78.7% vs 66.1%, log-rank test: P = 0.02), and fewer repeat procedures (6.6% vs 23%; P = 0.04), as compared to Group I.


CONCLUSIONS
PVI incorporating the high frequency AF nests adjacent to the PV ostia had a better single procedure efficacy.
Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Yenn-Jiang
YJ
Lin
Shih-Lin
SL
Chang
Li-Wei
LW
Lo
Yu-Feng
YF
Hu
Kazuyoshi
K
Suenari
Cheng-Hung
CH
Li
Tze-Fan
TF
Chao
Fa-Po
FP
Chung
Jo-Nan
JN
Liao
Beny
B
Hartono
Han-Wen
HW
Tso
Hsuan-Ming
HM
Tsao
Jin-Long
JL
Huang
Tsair
T
Kao
Shih-Ann
SA
Chen
D000200:Action Potentials; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001341:Autonomic Nervous System / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome