Single-ring isolation resulted in better 2-year atrial fibrillation-free survival compared with wide antral isolation (74% vs 61%; P=0.031), but did not reduce recurrence of all atrial arrhythmias.
RCT (n=220)
2x2 factorial
Does single-ring isolation reduce the recurrence of atrial fibrillation and organized atrial tachyarrhythmias compared to wide antral isolation in patients with highly symptomatic atrial fibrillation?
Single-ring isolation improves long-term freedom from atrial fibrillation compared to wide antral isolation, though it does not significantly reduce the recurrence of all atrial arrhythmias.
Absolute Event Rate: 74% vs 61%
p-value: p=0.031
BACKGROUND: Electric isolation of the pulmonary veins and posterior left atrium with a single ring of radiofrequency lesions (single-ring isolation SRI) may result in fewer atrial fibrillation (AF) recurrences than wide antral pulmonary vein isolation (wide antral isolation WAI) by abolishing extravenous AF triggers. The effect of mitral isthmus line (MIL) ablation on outcomes after SRI has not previously been assessed. METHODS AND RESULTS: We randomly assigned 220 consecutive patients (58 ± 10 years old; 82% men) with highly symptomatic AF (61% paroxysmal, 39% persistent/longstanding persistent) to undergo either SRI or WAI. Half of each cohort was also randomly allocated to have left lateral MIL ablation (2 ×2 factorial study design). Patients were followed clinically and with 7-day Holter studies for arrhythmia recurrences. The primary end points were recurrence of AF and organized atrial tachyarrhythmias. AF-free survival at 2 years was better after SRI (74% 95% CI, 65%-82%) than WAI (61% 51%-70%; P=0.031). Organized atrial tachyarrhythmia-free survival was similar after SRI and WAI (67% 57%-75% ersus 64% 54%-72%, respectively, at 2 years; P=0.988). MIL ablation resulted in better 2-year organized atrial tachyarrhythmia-free survival (71% 62%-79% versus 60% 50%-69%; P=0.07), which approached statistical significance. Survival free of any atrial arrhythmia after one procedure was not significantly affected by isolation technique or MIL ablation. Conclusions- SRI resulted in fewer AF recurrences compared with WAI on long-term follow-up but did not reduce the recurrence of all atrial arrhythmias. MIL ablation may reduce organized atrial tachyarrhythmia recurrences. Clinical Trial Registration- http://www.anzctr.org.au; ACTRN12606000467538.
Lim et al. (Sat,) conducted a rct in highly symptomatic atrial fibrillation (n=220). Single-ring isolation vs. Wide antral pulmonary vein isolation was evaluated on recurrence of AF (reported as AF-free survival) (p=0.031). Single-ring isolation resulted in better 2-year atrial fibrillation-free survival compared with wide antral isolation (74% vs 61%; P=0.031), but did not reduce recurrence of all atrial arrhythmias.
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