Circumferential pulmonary vein isolation alone resulted in similar AF-free survival compared with CPVI plus linear ablation (P=0.206) but required significantly shorter procedure times.
RCT (n=113)
Yes
Does circumferential pulmonary vein isolation alone improve outcomes or reduce procedure time compared to CPVI plus linear ablation in patients with persistent atrial fibrillation converted to paroxysmal AF?
In patients with persistent AF converted to paroxysmal AF, CPVI alone is as effective as CPVI plus linear ablation for maintaining sinus rhythm, while significantly reducing procedure and ablation times.
p-value: p=0.206
Background— Atrial fibrillation (AF) type can vary depending on condition and timing, and some patients who initially present with persistent AF may be changed to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether circumferential pulmonary vein isolation (CPVI) alone is an effective rhythm control strategy in patients with persistent AF to paroxysmal AF. Methods and Results— We enrolled 113 patients with persistent AF to paroxysmal AF (male 75%, 60.4±10.1 years old) who underwent catheter ablation for nonvalvular AF at 3 tertiary hospitals. The participants were randomly assigned to 2 groups: CPVI alone (n=59) or CPVI plus linear ablation (CPVI+Line; posterior box+anterior line, n=54). Compared with the CPVI+Line, CPVI alone required shorter procedure (187.2±58.0 versus 211.2±63.9 min; P =0.043) and ablation times (4922.1±1110.5 versus 6205.7±1425.2 s; P <0.001) without difference in procedure-related major complication (3% versus 2%; P =0.611). Antiarrhythmic drug utility rates after ablation were not different between the 2 groups (22% versus 30%; P =0.356). Overall, AF-free survival (log-rank; P =0.206) and AF and antiarrhythmic drug–free survival (log-rank; P =0.321) were not different between groups. Conclusions— CPVI alone is an effective rhythm control strategy with a shorter procedure time in persistent AF patients converted to paroxysmal AF compared with CPVI with linear ablation. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02176616.
Yu et al. (Thu,) conducted a rct in Persistent atrial fibrillation converted to paroxysmal atrial fibrillation (n=113). Circumferential pulmonary vein isolation (CPVI) alone vs. CPVI plus linear ablation was evaluated on AF-free survival (p=0.206). Circumferential pulmonary vein isolation alone resulted in similar AF-free survival compared with CPVI plus linear ablation (P=0.206) but required significantly shorter procedure times.