Linear lesions added to PVI and CFAE ablation yielded a significantly lower rate of freedom from atrial arrhythmia at 12 months compared to direct current cardioversion (16% vs 37%; P=0.03).
RCT (n=90)
randomized
Does the addition of linear lesions to PVI and CFAE ablation improve freedom from arrhythmia recurrence in patients with persistent atrial fibrillation?
Tasa de eventos absoluta: 16% vs 37%
valor p: p=0.03
BACKGROUND: For persistent atrial fibrillation (AF) ablation, different strategies including complex fractionated atrial electrograms (CFAE) ablation and linear lesions (LL) have been used in addition to pulmonary vein isolation (PVI). However, it is still a matter of debate if extended substrate modification improves long-term outcome. The aim of this study was to determine the benefit of LL in addition to PVI and CFAE ablation regarding freedom from arrhythmia recurrence in patients with persistent AF. METHODS: The study was a prospective randomized trial including 90 patients with persistent and longstanding persistent AF. All patients underwent PVI and CFAE ablation. If AF did not terminate to atrial tachycardia (AT) or sinus rhythm, patients were randomized to direct current cardioversion (Group 1; n = 45) or LL (Group 2; n = 45). Primary endpoint was freedom from any atrial arrhythmia off antiarrhythmic drugs at 12 months. (NCT02059369) RESULTS: Baseline characteristics were similar between the two groups with more than half of the patients having structural heart disease. The primary endpoint was reached in 37% in Group 1 (G1) and 16% in Group 2 (G2; P = 0.03). After a total number of 1.4 ± 0.5 (G1) versus 1.7 ± 0.4 (G2; P = 0.01) procedures, freedom from any arrhythmia was reached in 54% in G1 and 65% in G2 (P = 0.35). CONCLUSION: In persistent AF ablation, LL in addition to PVI and CFAE show a significantly lower success rate after a single procedure compared to PVI and CFAE. Following LL, significantly more patients needed a reablation to reach a similar success rate during a 12-month follow-up.
Ammar‐Busch et al. (Sun,) conducted a rct in persistent and longstanding persistent atrial fibrillation (n=90). Linear lesions (LL) vs. Direct current cardioversion was evaluated on freedom from any atrial arrhythmia off antiarrhythmic drugs at 12 months (p=0.03). Linear lesions added to PVI and CFAE ablation yielded a significantly lower rate of freedom from atrial arrhythmia at 12 months compared to direct current cardioversion (16% vs 37%; P=0.03).