title: Pulmonary Vein Isolation With Incomplete Antral Ablation Lines: Is More Ablation Necessary? Results of a Randomized Trial.
abstract: BACKGROUND
  A full circumferential set of antral lesions is not always required for bidirectional pulmonary vein conduction block. It is unknown whether a partial lesion set that isolates the veins will have clinical success rates similar to a full circumferential lesion set, and if procedural times or procedural risk will be affected.
  
  
  METHODS
  We performed a prospective, randomized clinical trial to test the hypothesis that a partial lesion set that isolates the pulmonary veins has comparable clinical success rate and shorter procedure times compared to a strategy of completing the circumferential lesion set once the veins are isolated.
  
  
  RESULTS
  A total of 119 patients were enrolled, 59 randomized to circumferential ablation, and 60 to segmental. Mean age was 58.3 ± 10.1, 77% male. Mean procedure time was 221.0 ± 46.9 minutes in circumferential and 224.7 ± 51.3 in segmental (P = 0.68). Twelve-month freedom from AF recurrence was 61.3% overall, 64.4% in circumferential, and 58.3% in segmental (P = 0.50). Among 25 segmental patients with AF recurrence, 23 underwent second ablation. Among 33 areas of conduction recovery, 23 (70%) occurred in segments ablated at first procedure and 10 (30%) in segments not previously ablated, suggesting reversible conduction block from edema.
  
  
  CONCLUSIONS
  No difference in AF recurrence or procedure time is detectable in a sample of 119 patients randomized to segmental or circumferential antral ablation to achieve pulmonary vein isolation. Second ablation procedures confirmed that some antral sites do not require ablation. A segmental approach results in unacceptably high rates of untargeted or recovered antral sites to make this approach feasible.
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: Lorne J
authors.initials: LJ
authors.lastname: Gula
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Leong-Sit
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: Jaimie
authors.initials: J
authors.lastname: Manlucu
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hillock
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: Raymond
authors.initials: R
authors.lastname: Yee
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: Anthony S L
authors.initials: AS
authors.lastname: Tang
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: George J
authors.initials: GJ
authors.lastname: Klein
authors.affiliation: Arrhythmia Service, University Hospital, Western University, London, Ontario, Canada.
authors.forename: Allan C
authors.initials: AC
authors.lastname: Skanes
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence
keywords: atrial arrhythmias; atrial fibrillation; catheter ablation; clinical trial; pulmonary vein isolation