Key result
Pulmonary vein isolation at the time of cavotricuspid isthmus ablation significantly increased long-term freedom from arrhythmias compared to CTI ablation alone (87% vs 44%, P<0.05).
Why the study?
Does prophylactic pulmonary vein isolation at the time of cavotricuspid isthmus ablation improve long-term freedom from arrhythmias in patients with lone persistent atrial flutter without documented atrial fibrillation?
RCT (n=48)
Does prophylactic pulmonary vein isolation at the time of cavotricuspid isthmus ablation improve long-term freedom from arrhythmias in patients with lone persistent atrial flutter without documented atrial fibrillation?
Prophylactic pulmonary vein isolation at the time of cavotricuspid isthmus ablation for lone persistent atrial flutter significantly improves long-term freedom from arrhythmias compared to CTI ablation alone.
Answers are grounded in this paper and cite their sources.
Supports adding prophylactic PVI to CTI ablation in lone persistent AFL; extends RCT evidence to patients without documented AF.
UNLABELLED: AF Ablation in Patients With Only Documentation of Atrial Flutter. OBJECTIVES: The aim of the study was to evaluate whether isolation of the pulmonary veins (PVs) at the time of cavotricuspid isthmus (CTI) ablation is beneficial in patients with lone atrial flutter (AFL). BACKGROUND: A high proportion of patients with lone persistent AFL have recurrent episodes of atrial fibrillation (AF) after CTI ablation. However, the benefit of AF ablation in patients with only documentation of AFL has not been determined. METHODS: Forty-eight patients with typical lone persistent AFL (age 56 ± 6; 90% male) were randomized to CTI ablation (Group A; n = 25) or to CTI + PV isolation (PVI) (Group B; n = 23). In addition to PVI, some patients in group B underwent ablation of complex fractionated electrograms and/or creation of left atrial roof and mitral isthmus ablation line in a stepwise approach when AF was induced and sustained for more than 2 minutes. Mean follow-up was 16 ± 4 months with a 48-hour ambulatory monitor every 2 months. RESULTS: There were no recurrences of AFL in either group. Six patients in group B (22%) underwent a stepwise ablation protocol. AF organized and terminated in 5 patients during ablation (83%). Complication rate was not significantly different among the groups. Twenty patients in group B (87%) and 11 patients in group A (44%) were free of arrhythmias on no medications at the end of follow-up (P < 0.05). CONCLUSIONS: Ablation of AF at the time of CTI ablation results in a significantly better long-term freedom from arrhythmias.
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NAVARRETE et al. (2010) conducted an RCT in Lone persistent atrial flutter without documented atrial fibrillation (n=48). Cavotricuspid isthmus (CTI) ablation + pulmonary vein isolation (PVI) vs. CTI ablation alone was evaluated on Freedom from arrhythmias on no medications at the end of follow-up (p=<0.05). Pulmonary vein isolation at the time of cavotricuspid isthmus ablation significantly increased long-term freedom from arrhythmias compared to CTI ablation alone (87% vs 44%, P<0.05).
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