title: Linear ablation in addition to circumferential pulmonary vein isolation (Dallas lesion set) does not improve clinical outcome in patients with paroxysmal atrial fibrillation: a prospective randomized study.
abstract: OBJECTIVE
  Although the concept of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) was derived from maze surgery, it is unclear if linear ablation in addition to circumferential pulmonary vein isolation (CPVI) reduces the recurrence rate in patients with paroxysmal AF. Therefore, we compared clinical outcomes of CPVI with additional linear ablations (Dallas lesion set) and CPVI in a prospective randomized controlled study among patients with paroxysmal AF.
  
  
  RESULTS
  This study enrolled 100 paroxysmal AF patients (male 75.0%, 56.4 ± 11.6 years old) who underwent RFCA and were randomly assigned to the CPVI group (n = 50) or the catheter Dallas lesion group (CPVI, posterior box lesion, and anterior linear ablation, n = 50). The catheter Dallas lesion group required longer procedure (190.3 ± 46.3 vs. 161.1 ± 30.3 min, P < 0.001) and ablation times (5345.4 ± 1676.4 vs. 4027.2 ± 878.0 s, P < 0.001) than the CPVI group. Complete bidirectional conduction block rate was 68.0% in the catheter Dallas lesion group and 100% in the CPVI group. Procedure-related complication rates were not significantly different between the catheter Dallas lesion (0%) and CPVI groups (4%, P = 0.157). During the 16.3 ± 4.0 months of follow-up, the clinical recurrence rates were not significantly different between the two groups (16.0% in the catheter Dallas lesion group vs. 12.0% in the CPVI group, P = 0.564), regardless of complete bidirectional conduction block achievement after linear ablation.
  
  
  CONCLUSIONS
  Linear ablation in addition to CPVI (catheter Dallas lesion) did not improve clinical outcomes of RFCA in paroxysmal AF patients and required longer procedure times.
authors.affiliation: Department of Cardiology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Junbeom
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Cardiology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Jin-Kyu
authors.initials: JK
authors.lastname: Park
authors.affiliation: Department of Cardiology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Department of Cardiology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Utah Valley Regional Medical Center, 1055 North 500 West, Provo, Utah 84604, USA.
authors.forename: Chun
authors.initials: C
authors.lastname: Hwang
authors.affiliation: Department of Cardiology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea hnpak@yuhs.ac.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
keywords: Catheter Dallas lesion; Catheter ablation; Paroxysmal atrial fibrillation; Recurrence