title: Prolonged ablation on critical segments of pulmonary vein ostia in paroxysmal atrial fibrillation: a prospective randomized controlled study.
abstract: BACKGROUND
  Electrical reconnection of the pulmonary veins (PVs) plays a key role in the recurrence of atrial fibrillation (AF) after ablative treatment. This randomized controlled study tested the hypothesis that prolonged ablations, on areas that may be critical for left atrial (LA)-PV conduction, can significantly reduce the rate of acute PV reconnection and AF recurrence.
  
  
  METHODS
  Patients with paroxysmal AF were randomly assigned to either a control or an add-on group.Ostial PV isolation (PVI) was performed by point-to-point RF ablation (irrigated tip, 30 Watts, 30 seconds).An ostial segment was assumed to be critical for LA-PV connection if any of the following reactions occurred during RF application: (1) sudden delay of LA-PV conduction, (2) change of activation sequence,and (3) PVI. In this case, RF application was prolonged from 30 seconds to 90 seconds in the add-on group only.
  
  
  RESULTS
  A total of 131 patients (58 ± 11 years, 47 female) were assigned to a control (n = 64) and an add-on (n = 67) group. Ablation time was longer in the add-on (48 ± 16 minutes vs 37 ± 15 minutes, P = 0.03). Acute PV reconnection was observed in 20 of 64 controls and in eight of 66 add-on patients (31% vs 12%, P < 0.001). During a follow-up of 26 months, AF recurred in 33 of 64 controls and in 16 of 66 add-on patients (52% vs 24%, P = 0.001) after a single ablation procedure.
  
  
  CONCLUSIONS
  Prolonged radiofrequency application on critical segments of LA-PV connection is a safe and effective ablative strategy that significantly reduces acute PV reconnection and AF recurrence rates after a single ablation procedure for paroxysmal AF.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kriatselis
authors.forename: Jan
authors.initials: J
authors.lastname: Kaufmann
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.forename: Min
authors.initials: M
authors.lastname: Tang
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerds-Li
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome