Key result
Driver ablation plus PVI yielded higher AF termination (93.9% vs 40.6%; P<0.001) and 6-month freedom from atrial tachyarrhythmia (91.6% vs 72.4%; P=0.02) than PVI alone in paroxysmal AF.
Why the study?
Does driver ablation plus PVI improve AF termination and freedom from atrial tachyarrhythmia episodes in patients with paroxysmal AF compared to PVI alone?
RCT (n=98)
Does driver ablation plus PVI improve AF termination and freedom from atrial tachyarrhythmia episodes in patients with paroxysmal AF compared to PVI alone?
Driver ablation adjunctive to PVI significantly increases AF termination rates and improves 6-month freedom from atrial tachyarrhythmia in patients with paroxysmal AF compared to PVI alone.
Answers are grounded in this paper and cite their sources.
Observational data support adjunctive driver ablation for paroxysmal AF; leaves open need for randomized validation before practice change.
BACKGROUND: The adjunctive approach is still unknown for atrial fibrillation (AF), which cannot be terminated after pulmonary vein isolation (PVI). We hypothesized that the driver ablation plus PVI was superior to PVI alone. METHODS AND RESULTS: A total of 98 patients with paroxysmal AF were enrolled in this study and were divided into two groups, with one group undergoing PVI (n = 49) and the other group undergoing PVI + driver ablation (n = 49). The driver regions were defined as clusters of bipolar electrograms that displayed spatial dispersion spread over mean AF cycle length at a minimum of three adjacent bipolars of a PentaRay catheter. During the procedure, the most prominent driver regions before PVI were the roof (n = 27; 55.1%), PV antrum (n = 23; 46.9%), and the inferoposterior wall (n = 11; 22.4%). PVI can eliminate all drivers at PV antrum, but only terminate 30.4% of AF in the driver group. The AF termination rate in the driver ablation group was significantly higher than that in conventional ablation (93.9% vs 40.6%; P < 0.001). The rate of freedom from atrial tachyarrhythmia episodes by a single procedure at 6 months was significantly higher in the driver group than in the conventional group (91.6% vs 72.4%; P = 0.02). CONCLUSION: The present method is effective for AF driver identification. It guided ablation adjunctive to PVI increasing the rate of AF termination and improving the outcomes in patients with paroxysmal AF.
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Qin et al. (2018) conducted an RCT in Paroxysmal atrial fibrillation (n=98). PVI + driver ablation vs. PVI alone was evaluated on AF termination rate (p=<0.001). Driver ablation plus PVI yielded higher AF termination (93.9% vs 40.6%; P<0.001) and 6-month freedom from atrial tachyarrhythmia (91.6% vs 72.4%; P=0.02) than PVI alone in paroxysmal AF.
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