Document Detail


Single procedure efficacy of isolating all versus arrhythmogenic pulmonary veins on long-term control of atrial fibrillation: a prospective randomized study.
MedLine Citation:
PMID:  18242535     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Current atrial fibrillation (AF) ablation involves isolation of all pulmonary veins (PVs) with or without additional linear lesions. However, whether such extensive ablation is necessary is unclear. OBJECTIVE: The purpose of this study was to assess the efficacy of different ablation strategies on long-term AF control. METHODS: We prospectively randomized patients to undergo isolation of all versus arrhythmogenic PVs (identified by standardized stimulation protocol). PV isolation was guided by circular mapping catheter. The endpoint was entry/exit block persisting for > or = 20 minutes. Patients were evaluated at three clinic visits (at 6 weeks, 6 months, and 1 year) and multiple transtelephonic monitoring periods. Antiarrhythmic drugs were discontinued at 6 weeks. Primary study endpoint was long-term AF control (freedom or >90% reduction in AF burden off or on previously ineffective antiarrhythmic drugs at 1 year after a single ablation procedure). RESULTS: Over a 20-month period, 105 patients (76 men and 29 women, age 57 +/- 9 years; paroxysmal AF = 77) were randomized, and 103 patients completed 1-year follow-up (51 patients in all-PV arm, 52 patients in arrhythmogenic PV arm). The primary endpoint was achieved in 75 (73%) patients and was similar in patients randomized to all-PV arm versus arrhythmogenic PV arm [38 (75%) patients vs 37 (71%) patients, respectively; odds ratio 1.18, 95% confidence interval 0.50, 2.83, P = .70]. Secondary study endpoints, including freedom from AF off antiarrhythmic drugs, total procedure/fluoroscopy times, and occurrence of serious adverse events, were not different between the two groups. CONCLUSION: In a randomized comparison, isolation of arrhythmogenic veins was as efficacious as empiric isolation of all veins in achieving long-term AF control.
Authors:
Sanjay Dixit; Edward P Gerstenfeld; Sarah J Ratcliffe; Joshua M Cooper; Andrea M Russo; Stephen E Kimmel; David J Callans; David Lin; Ralph J Verdino; Vickas V Patel; Erica Zado; Francis E Marchlinski
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-10-02
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  5     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-04     Completed Date:  2008-04-29     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  174-81     Citation Subset:  IM    
Affiliation:
Cardiovascular Division, Hospital of The University of Pennsylvania and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Sanjay.Dixit@uphs.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / physiopathology,  prevention & control,  surgery*
Catheter Ablation*
Female
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Veins / pathology*
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Heart Rhythm. 2008 Feb;5(2):182-3   [PMID:  18242536 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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