title: Benefit of pulmonary vein isolation guided by loss of pace capture on the ablation line: results from a prospective 2-center randomized trial.
abstract: OBJECTIVE
  This study was conducted to determine if an additional procedural endpoint of unexcitability (UE) to pacing along the ablation line reduces recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) after radiofrequency catheter ablation.
  
  
  BACKGROUND
  AF/AT recurrence is common after pulmonary vein isolation (PVI).
  
  
  METHODS
  We included 102 patients from 2 centers (age 63 ± 10 years; 33 women; left atrium 38 ± 7 mm; left ventricular ejection fraction 61 ± 6%) with symptomatic paroxysmal AF. A 3-dimensional mapping system and circumferential mapping catheter were used in all patients for PVI. In group 1 (n = 50), the procedural endpoint was bidirectional block across the ablation line. In group 2 (n = 52), additional UE to bipolar pacing at an output of 10 mA and 2-ms pulse width was required. The primary endpoint was freedom from any AF/AT (>30 s) after discontinuation of antiarrhythmic drugs.
  
  
  RESULTS
  Procedural endpoints were successfully achieved in all patients. Procedure duration was significantly longer in group 2 (185 ± 58 min vs. 139 ± 57 min; p < 0.001); however, fluoroscopy times were not different (23 ± 9 min vs. 23 ± 9 min; p = 0.49). After a follow-up of 12 months in all patients, 26 patients (52%) in group 1 versus 43 (82.7%) in group 2 were free from any AF/AT (p = 0.001) after a single procedure. No major complications occurred.
  
  
  CONCLUSIONS
  The use of pacing to ensure UE along the PVI line markedly improved near-term single-procedure success, compared with demonstration of bidirectional block alone. This additional endpoint significantly improved patient outcomes after PVI. (Unexcitability Along the Ablation as an Endpoint for Atrial Fibrillation Ablation; NCT01724437).
authors: Department for Cardiac Electrophysiology, University Heart Center, Hamburg, Germany. daniel.steven@me.com
authors: Daniel
authors: D
authors: Steven
authors: Arian
authors: A
authors: Sultan
authors: Vivek
authors: V
authors: Reddy
authors: Jakob
authors: J
authors: Luker
authors: Manuel
authors: M
authors: Altenburg
authors: Boris
authors: B
authors: Hoffmann
authors: Thomas
authors: T
authors: Rostock
authors: Helge
authors: H
authors: Servatius
authors: William G
authors: WG
authors: Stevenson
authors: Stephan
authors: S
authors: Willems
authors: Gregory F
authors: GF
authors: Michaud
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000502:physiology / Q000601:surgery; D016896:Treatment Outcome