title: Pulmonary Vein Isolation to Reduce Future Risk of Atrial Fibrillation in Patients Undergoing Typical Flutter Ablation: Results from a Randomized Pilot Study (REDUCE AF).
abstract: BACKGROUND
  This study examined incidence of AF following cavotricuspid isthmus (CTI) ablation alone or CTI plus prophylactic pulmonary vein isolation (PVI) in patients presenting with isolated atrial flutter (AFL) with no history of AF.
  
  
  RESULTS
  We enrolled 216 patients with isolated typical atrial flutter and randomized them to CTI alone (group 1, n = 108, 61.2 ± 9.7 year, 75% male) or CTI+PVI ablation (group 2, n = 108, 62.4 ± 9.3 year, 73% male). Insertible loop recorder (ILR) was implanted in 21 and 19 patients from groups 1 and 2, respectively. Remaining patients were monitored with event recorders, ECG, 7-day Holter. Follow-up period was for 18 ± 6 months. Compared to group 1, group 2 had significantly longer procedural duration (75.9 ± 33 min vs. 161 ± 48 min [P < 0.001]) and fluoroscopy time (15.9 ± 12.3 min vs. 56.4+21 min [P < 0.001]). At the end of follow-up, 65 (60.2%) in group 1 and 77 (71.3%) in group 2 were arrhythmia free off-AAD (log-rank P = 0.044). A subgroup analysis was performed with 55 year age cut-off. In the <55 age group the CTI only population had similar success as in CTI+PVI, (21 of 24 [83.3%] vs. 19 of 22 [86.4%], respectively, log-rank P = 0.74). In the ≥55 group, having CTI+PVI showed significantly higher success compared to CTI only; 45 of 84 (53.6%) were AF/AT free in CTI only group versus 58 of 86 (67.4%) with CTI+PVI (log-rank P = 0.029).
  
  
  CONCLUSIONS
  Prophylactic PVI reduced new-onset AF in patients with lone atrial flutter.
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.|Department of Internal Medicine, Dell Medical School, Austin, Texas, USA.|California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.|Albert Einstein College of Medicine at Montefiore Hospital, New York, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: DI Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.affiliation: University of Pennsylvania, Pennsylvania, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: G Joseph
authors.initials: GJ
authors.lastname: Gallinghouse
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Hranitzky
authors.affiliation: Univ Tor Vergata, Rome, Italy.
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.affiliation: California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.affiliation: California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.affiliation: California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.affiliation: Catholic University, Rome, Italy.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Forleo
authors.affiliation: Ospedale dell' Angelo, Mestre /Venice, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossillo
authors.affiliation: Ospedale dell' Angelo, Mestre /Venice, Italy.
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.affiliation: RCCS Monzino Hospital, Milan, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.affiliation: RCCS Monzino Hospital, Milan, Italy.
authors.forename: Antonio Dello
authors.initials: AD
authors.lastname: Russo
authors.affiliation: RCCS Monzino Hospital, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
authors.affiliation: University of Pennsylvania, Pennsylvania, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D001282:Atrial Flutter / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: cavotricuspid isthmus ablation; new-onset atrial fibrillation; outcome; prophylactic pulmonary vein isolation; typical atrial flutter