Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: the PReVENT AF Study I.
BACKGROUND
Although catheter ablation of isthmus-dependent atrial flutter (AFL) is successful at eliminating the target arrhythmia, many patients subsequently experience new-onset atrial fibrillation (AF).


OBJECTIVE
The aim of this study was to determine whether AF can be prevented by prophylactic pulmonary vein ablation in patients with AFL.


METHODS
A prospective, single-blind, randomized clinical trial in patients whose sole arrhythmia was AFL without AF was conducted. Patients were randomized to cavotricuspid isthmus ablation alone or with concomitant pulmonary vein isolation. All patients received an implantable cardiac monitor.


RESULTS
Fifty patients completed the trial, and patients were well matched. Isthmus ablation was successful in all patients; pulmonary vein isolation was successful in 25 (100%) randomized patients. Procedure (P < .0001) and fluoroscopy (P < .0001) times were longer in the combined ablation group. More patients in the isthmus ablation-only group experienced new-onset AF during follow-up (52% vs. 12%; P = .003). The 1-year AF burden also favored the combined ablation group compared with the isthmus ablation-only group (8.3% vs. 4.0%; P = .034). In the isthmus ablation-only group, 8 (32%) patients subsequently underwent another ablation for AF. The performance of pulmonary vein isolation and male sex were independent predictors of freedom from AF.


CONCLUSIONS
In the PREVENT-AF Study I randomized clinical trial of patients in whom only typical AFL had been observed clinically, the addition of pulmonary vein isolation to cavotricuspid isthmus ablation resulted in a marked reduction of new-onset AF during clinical follow-up as assessed with a continuous implantable cardiac monitor.
The Arrhythmia Institute, Valley Health System, New York, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York. Electronic address: jss7@columbia.edu.
Jonathan S
JS
Steinberg
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Alexander
A
Romanov
The Arrhythmia Institute, Valley Health System, New York, New York.
Dan
D
Musat
The Arrhythmia Institute, Valley Health System, New York, New York.
Mark
M
Preminger
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Sevda
S
Bayramova
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Sergey
S
Artyomenko
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Vitaliy
V
Shabanov
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Denis
D
Losik
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Alexander
A
Karaskov
The Arrhythmia Institute, Valley Health System, New York, New York.
Richard E
RE
Shaw
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Evgeny
E
Pokushalov
D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016037:Single-Blind Method; D016896:Treatment Outcome
Atrial fibrillation; Atrial flutter; Catheter ablation; Cavotricuspid isthmus; Prophylactic; Pulmonary vein isolation