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Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies.

Abstract：

BACKGROUND:This prospective multicenter randomized study aimed to compare the efficacy of 3 common ablation methods used for longstanding permanent atrial fibrillation (AF). METHODS:A total of 144 patients with longstanding permanent AF (median duration 28 months) were randomly assigned to circumferential pulmonary vein ablation (CPVA, group 1, n = 47), to pulmonary vein antrum isolation (PVAI, group 2, n = 48) or to a hybrid strategy combining ablation of complex fractionated or rapid atrial electrograms (CFAE) in both atria followed by a pulmonary vein antrum isolation (CFAE + PVAI, group 3, n = 49). RESULTS:Scarring in the left atrium and structural heart disease/hypertension were present in most patients (65%). After a mean follow-up of 16 months, 11% of patients in group 1, 40% of patients in group 2 and 61% of patients in group 3 were in sinus rhythm after one procedure and with no antiarrhythmic drugs (P < .001). Sinus rhythm maintenance would increase respectively to 28% (group 1), 83% (group 2), and 94% (group 3) after 2 procedures and with antiarrhythmic drugs (AADs, P < .001). The AF terminated during ablation, either by conversion to sinus rhythm or organization into an atrial tachyarrhythmia, in 13% of patients (group 1), 44% (group 2), and 74% (group 3) respectively. CFAE alone, performed as the first step of the ablation in group 3, organized AF in only 1 patient. CONCLUSION:In this study, the hybrid AF ablation strategy including antrum isolation and CFAE ablation had the highest likelihood of maintaining sinus rhythm in patients with longstanding permanent AF. Electrical isolation of the PVs, although inadequate if performed alone, is relevant to achieve long-term sinus rhythm maintenance after ablation. Bi-atrial CFAE ablation had a minimal impact on AF termination during ablation.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Elayi CS,Verma A,Di Biase L,Ching CK,Patel D,Barrett C,Martin D,Rong B,Fahmy TS,Khaykin Y,Hongo R,Hao S,Pelargonio G,Dello Russo A,Casella M,Santarelli P,Potenza D,Fanelli R,Massaro R,Arruda M,Schweikert RA,Nata

doi

10.1016/j.hrthm.2008.09.016

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

1658-64

issue

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(08)00917-X

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies.