title: Arrhythmia Termination Versus Elimination of Dormant Pulmonary Vein Conduction as a Procedural End Point of Catheter Ablation for Paroxysmal Atrial Fibrillation: A Prospective Randomized Trial.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) is still associated with a substantial number of arrhythmia recurrences in paroxysmal atrial fibrillation (AF). This prospective, randomized study aimed to compare 2 different procedural strategies.
  
  
  RESULTS
  A total of 152 patients undergoing de novo ablation for paroxysmal AF were randomized to 2 different treatment arms. The procedure in group A consisted of PVI exclusively. In this group, all isolated PVs were challenged with adenosine to reveal and ablate dormant conduction. In group B, PVI was performed with the patient either in spontaneous or in induced AF. If AF did not terminate with PVI, ablation was continued by targeting extra-PV AF sources with the desired procedural end point of termination to sinus rhythm. Primary study end point was freedom from arrhythmia during 1-year follow-up. In group A, adenosine provoked dormant conduction in 31 (41%) patients with a mean of 1.6±0.8 transiently recovered PVs per patient. Termination of AF during PVI was observed in 31 (65%) patients, whereas AF persisted afterward in 17 (35%) patients. AF termination occurred in 13 (76%) patients by AF source ablation. After 1-year follow-up, significantly more group B patients were free of arrhythmia recurrences (87 versus 68%; P=0.006). During redo ablation, the rate of PV reconduction did not differ between both groups (group A: 55% versus group B: 61%; P=0.25).
  
  
  CONCLUSIONS
  Elimination of extra-PV AF sources after PVI is superior to sole PV isolation with the adjunct of abolishing potential dormant conduction.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02238392.
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Cathrin
authors: C
authors: Theis
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Torsten
authors: T
authors: Konrad
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Hanke
authors: H
authors: Mollnau
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Sebastian
authors: S
authors: Sonnenschein
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Denise
authors: D
authors: Kämpfner
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Maik
authors: M
authors: Potstawa
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Blanca Quesada
authors: BQ
authors: Ocete
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Karsten
authors: K
authors: Bock
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Ewald
authors: E
authors: Himmrich
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
authors: Thomas
authors: T
authors: Münzel
authors: From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany. throstock@gmail.com.
authors: Thomas
authors: T
authors: Rostock
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine
keywords: arrhythmias, cardiac; atrial fibrillation; catheter ablation; follow-up studies; pulmonary veins