Additional radiofrequency ablation for dissociated pulmonary vein activity after isolation reduced atrial fibrillation recurrence, with remaining spikes predicting recurrence (HR 2.44; 95% CI 1.10-5.43).
RCT (n=152)
Randomly assigned
Does additional radiofrequency ablation for spontaneous dissociated pulmonary vein activity reduce atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation?
Additional radiofrequency ablation targeting spontaneous dissociated pulmonary vein activity after pulmonary vein isolation reduces the risk of atrial fibrillation recurrence.
Effect estimate: HR 2.44 (95% CI 1.10-5.43)
p-value: p=<0.05
BACKGROUND: The aim is to evaluate the efficacy of additional radiofrequency ablation (RFCA) for spontaneous dissociated pulmonary vein activity (DPV-spike) after PV isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). METHODS: One hundred fifty-two consecutive patients with paroxysmal AF referred for RFCA were enrolled. When DPV-spike was documented after PVI, we randomly assigned these patients to receive additional RFCA for DPV-spike or only PVI. We divided them into 4 groups: 87 patients without DPV-spike after PVI (No-spike group), 31 without DPV-spike after additional RFCA (Successful group), 8 with remaining DPV-spike after additional RFCA (Unsuccessful group), and 26 with DPV-spike after only PVI (Spike group). AF recurrence was evaluated among the 4 groups. RESULTS: After PVI, DPV-spike was documented in 87 PVs (14%) from 65 patients. During 16 ± 9 months of follow-up, the incidence of the freedom from AF was significantly higher in the No-spike group than that in the Spike group and Unsuccessful group (P < 0.05), and tended to be higher in the Successful group than that in the Spike group and Unsuccessful group (P = 0.08 and 0.11, respectively). In a multivariate analysis, the remaining PV-spike after ablation was an independent predictor of AF recurrence (HR 2.44; CI 1.10-5.43, P < 0.05). No major complications including PV stenosis were observed during the follow-up. CONCLUSIONS: DPV-spike after PVI may be associated with higher electrical activity within the PVs and may be one of the risk factors for AF recurrence. Additional RFCA for DPV-spike was effective to reduce the AF recurrence after PVI.
Doi et al. (Tue,) conducted a rct in Paroxysmal atrial fibrillation (n=152). Additional radiofrequency ablation for DPV-spike vs. Pulmonary vein isolation only was evaluated on Atrial fibrillation recurrence (HR 2.44, 95% CI 1.10-5.43, p=<0.05). Additional radiofrequency ablation for dissociated pulmonary vein activity after isolation reduced atrial fibrillation recurrence, with remaining spikes predicting recurrence (HR 2.44; 95% CI 1.10-5.43).
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