Prophylactic pulmonary vein isolation plus cavotricuspid isthmus ablation increased freedom from arrhythmia off antiarrhythmic drugs compared to CTI alone (71.3% vs 60.2%, P=0.044).
RCT (n=216)
Does prophylactic PVI added to CTI ablation reduce new-onset AF in patients with isolated typical atrial flutter?
Prophylactic PVI added to CTI ablation significantly reduces the incidence of new-onset AF in patients with isolated typical atrial flutter, particularly in those aged 55 years or older.
Absolute Event Rate: 71.3% vs 60.2%
p-value: p=0.044
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. METHODS AND 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). CONCLUSION: Prophylactic PVI reduced new-onset AF in patients with lone atrial flutter.
Mohanty et al. (Fri,) conducted a rct in Isolated typical atrial flutter with no history of atrial fibrillation (n=216). Cavotricuspid isthmus (CTI) plus prophylactic pulmonary vein isolation (PVI) ablation vs. CTI ablation alone was evaluated on Arrhythmia free off antiarrhythmic drugs (AAD) (p=0.044). Prophylactic pulmonary vein isolation plus cavotricuspid isthmus ablation increased freedom from arrhythmia off antiarrhythmic drugs compared to CTI alone (71.3% vs 60.2%, P=0.044).
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