November 15, 2011Circulation
Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST)
Why the study?
Does minimally invasive surgical ablation improve freedom from left atrial arrhythmia compared to catheter ablation in patients with antiarrhythmic drug-refractory atrial fibrillation?
Population
124 patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and…
Comparison
Minimally invasive surgical ablation consisting… vs Catheter ablation consisting of linear antral…
Design
RCT, Randomized to CA (63 patients) or SA (61 patients)
Follow-up
12 months
Authors
Discussion
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Member takes
Implication
SA superior for rhythm control in refractory AF despite higher adverse events; extends RCT evidence for ablation modality selection.
Key Points
- To compare the efficacy and safety of catheter ablation versus surgical ablation in patients with drug-refractory atrial fibrillation.
- 124 patients randomized to catheter ablation (CA) or surgical ablation (SA) with 12-month follow-up.
- CA involved linear antral pulmonary vein isolation; SA involved bipolar radiofrequency and left atrial appendage excision.
- Follow-up assessments included ECG and 7-day Holter monitoring.
- Freedom from left atrial arrhythmia >30 seconds after 12 months was 36.5% for CA and 65.6% for SA (P=0.0022).
- Significant adverse events were higher for SA (34.4%) than for CA (15.9%) (P=0.027).
- One patient in the CA group died from subarachnoid hemorrhage.
Structured PICO
Does minimally invasive surgical ablation improve freedom from left atrial arrhythmia compared to catheter ablation in patients with antiarrhythmic drug-refractory atrial fibrillation?
P
Population
124 patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension (n=42, 33%) or failed prior catheter ablation (n=82, 67%)
I
Intervention
Minimally invasive surgical ablation (SA) consisting of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation, and left atrial appendage excision with optional additional lines
C
Comparator
Catheter ablation (CA) consisting of linear antral pulmonary vein isolation and optional additional lines
O
Outcome
Freedom from left atrial arrhythmia >30 seconds without antiarrhythmic drugs after 12 months
In patients with refractory atrial fibrillation, surgical ablation is superior to catheter ablation for maintaining sinus rhythm at 12 months, but is associated with a significantly higher rate of procedural adverse events.
Cite This Study
Boersma et al. (2011) studied this question.