Key result
Complete ablation lines for radiofrequency isolation of pulmonary veins did not significantly improve permanent PV isolation at 3 months compared to incomplete lines (13.8% vs 20.8%, p=0.267).
Why the study?
The effect of complete versus incomplete ablation lines on permanent pulmonary vein isolation at 3 months and AF recurrence remained unclear.
Does a complete anatomical ablation line improve permanent isolation of pulmonary veins and reduce atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation?
RCT (n=60)
1:1
Does a complete anatomical ablation line improve permanent isolation of pulmonary veins and reduce atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation?
Creating an anatomically continuous ablation line after achieving electrical isolation of pulmonary veins does not significantly improve permanent PV isolation or clinical efficacy compared to incomplete lines in paroxysmal AF.
Answers are grounded in this paper and cite their sources.
Complete lines confer no durable PV isolation benefit in paroxysmal AF; challenges necessity of anatomical continuity.
Purpose . To compare the effect of the completed and incomplete ablation lines on the permanent isolation of the pulmonary veins (PV) during intracardiac electrophysiological (EP) examination 3 months after the operation, as well as to assess the frequency of recurrence of atrial fibrillation (AF) and its relationship with the reconnection in the PV. Methods . From January to December 2016, 60 patients with paroxysmal AF selected and operated. Patients were randomized into two groups in a 1:1 ratio. In the first group, after achieving isolation of PV, radiofrequency (RF) exposure continued until an anatomically continuous line of ablation was created. In the second group, after receiving electrical isolation of all PV, RF ablation was interrupted regardless of the anatomical completeness of the ablation line. After 3 months in a planned manner (regardless of clinical status), an endocardial EP study was performed to check the consistency of the input and output block of excitation in each PV and, if necessary, repeated RF ablation of the reconnection sites. Results . A total of 53 people completed the study. In the first group intracardiac EP examination was performed on 29 patients, in the second group - on 24 patients. In the first group 4 patients retained isolation of all PV (13.8%), and in the second group - 5 (20.8%). No significant difference between the groups was obtained (p = 0.267). Sinus rhythm 3 months after the first procedure was observed in 28 patients (52.8%), of which 78.5% had reconnection in at least one PV. The recurrence rate of AF between the groups did not differ (OR 0.488 95% CI 0.162-1.460 p = 0.563) In the first group after 15 months the sinus rhythm was observed in 19 of 29 patients (65.5%), in the second group in 18 of 24 patients (75%). Differences are not statistically significant (OR 0.633 95% CI 0.191-2.103 p = 0.612) Conclusions : in our study, there was no significant difference in the frequency of reconnection and the clinical efficacy of RF isolation of PV in groups with complete and incomplete ablation lines.
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Козлов et al. (2020) conducted an RCT in Paroxysmal atrial fibrillation (n=60). Complete ablation lines vs. Incomplete ablation lines was evaluated on Permanent isolation of all pulmonary veins at 3 months (p=0.267). Complete ablation lines for radiofrequency isolation of pulmonary veins did not significantly improve permanent PV isolation at 3 months compared to incomplete lines (13.8% vs 20.8%, p=0.267).
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