Key result
Left atrial plus cavotricuspid isthmus ablation resulted in similar rates of sinus rhythm maintenance compared to biatrial ablation at a mean follow-up of 28 months (85.2% vs 84.1%; p=0.87).
Why the study?
Does left atrial plus cavotricuspid isthmus ablation improve sinus rhythm restoration and safety compared to biatrial ablation in patients with permanent atrial fibrillation undergoing concomitant cardiac surgery?
RCT (n=299)
Open-label
Does left atrial plus cavotricuspid isthmus ablation improve sinus rhythm restoration and safety compared to biatrial ablation in patients with permanent atrial fibrillation undergoing concomitant cardiac surgery?
Absolute Event Rate: 85.2% vs 84.1%
p-value: p=0.87
Left atrial ablation combined with cavotricuspid isthmus ablation is as effective and safe as the biatrial maze procedure for treating permanent AF during concomitant cardiac surgery.
Left atrial plus cavotricuspid isthmus ablation matches biatrial ablation for sinus rhythm maintenance; confirms equivalent efficacy and supports simplified lesion sets in concomitant surgery.
OBJECTIVE: The aim of this study was to compare, in patients with permanent atrial fibrillation (AF), the efficacy and safety of left atrial ablation with that of a biatrial procedure and to assess the risk factors for late failure of sinus rhythm restoration. METHODS: Between January 2004 and January 2007, 299 consecutive patients underwent the radiofrequency ablation procedure for AF associated with concomitant cardiac surgery. According to a prospective, open, and randomized trial, 149 patients underwent left atrial plus cavotricuspid isthmus ablation (left atrial group), while 150 patients underwent biatrial ablation (biatrial group). The postoperative and mid-term follow-up results were compared between the two groups. Both univariate and multivariate analyses were used to assess the risk factors for late recurrence of AF. RESULTS: There were seven in-hospital deaths (2.3%), including two in the left atrial group (1.3%) and five in the biatrial group (3.3%), and there were no differences in the incidence of the mortality and complications during the postoperative and follow-up periods between the groups. At discharge, sinus rhythm was maintained in 77.1% of the patients, including 78.2% of those in the left atrial group and 75.9% in the biatrial group (p=0.68). Follow-up was completed in 97% of the patients, with a mean time of 28+/-5 months. At the latest follow-up, two deaths occurred in the biatrial group. Sinus rhythm was documented in 237 (85.0%) out of all the patients, including 85.2% (121/142) in the left atrial group and 84.1% (116/138) in the biatrial group patients (p=0.87). Using a multivariate analysis, a left atrial diameter of >/=80 mm (p=0.02) was an independent predictor for a late recurrence of AF. CONCLUSIONS: Both the left atrial combined with cavotricuspid isthmus ablation and biatrial maze procedure is safe and effective in treating patients with AF, with an acceptable sinus conversion rate, mortality and morbidity. A left atrial dimension of >/=80 mm was a significant predictor for a late recurrence of AF.
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Wang et al. (2008) conducted an RCT in Permanent atrial fibrillation associated with concomitant cardiac surgery (n=299). Left atrial plus cavotricuspid isthmus ablation vs. Biatrial ablation was evaluated on Maintenance of sinus rhythm at latest follow-up (p=0.87). Left atrial plus cavotricuspid isthmus ablation resulted in similar rates of sinus rhythm maintenance compared to biatrial ablation at a mean follow-up of 28 months (85.2% vs 84.1%; p=0.87).
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