Key result
Prophylactic pulmonary vein isolation with CTI ablation in typical atrial flutter increased 3-year freedom from atrial tachyarrhythmia compared to CTI alone (48% vs 20%; P=0.01).
Why the study?
Does prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation reduce the occurrence of atrial tachyarrhythmias in patients with pure typical atrial flutter?
RCT (n=50)
randomized
Does prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation reduce the occurrence of atrial tachyarrhythmias in patients with pure typical atrial flutter?
Absolute Event Rate: 48% vs 20%
p-value: p=0.01
Prophylactic pulmonary vein isolation during CTI ablation for typical atrial flutter significantly reduces long-term atrial tachyarrhythmia recurrence, AF burden, and hospitalizations at 3 years.
Sustained AF reduction at 3 years in this small pilot RCT; leaves open need for larger trials before considering prophylactic PVI in AFL.
INTRODUCTION: The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with pure typical atrial flutter (AFL) resulted in substantial reduction of new-onset atrial fibrillation (AF) during 1-year follow-up as assessed by continuous implantable cardiac monitor (ICM). The objective of this study was to assess 3-year outcomes. METHODS AND RESULTS: Fifty patients with documented AFL were randomized to either cavotricuspid isthmus (CTI) ablation alone (n = 25) or CTI with concomitant PVI (n = 25). The primary endpoint of the study was the occurrence of any atrial tachyarrhythmia with the monthly burden exceeding 0.5% on the ICM. At the end of 3 years, freedom from any atrial tachyarrhythmia was 48% (95% confidence interval [CI]: 32-72%) in the CTI plus PVI group as compared to 20% (95% CI: 9-44%) in the CTI-only group (P = 0.01). Freedom from redo procedures was also higher: 92% (95% CI: 82-100%) versus 68% (95% CI: 52-89%), respectively (P = 0.027). The 3-year AF burden favored the combined ablation group: 6.2% versus 16.8% (P = 0.03). In the CTI-only group, 12 (48%) patients were hospitalized compared to 4 (16%) in the PVI + CTI group (P = 0.03). Two patients in the CTI-only group developed stroke with no serious adverse events in the PVI + CTI group. CONCLUSION: Prophylactic PVI in patients with only typical AFL resulted in a significant reduction of new-onset AF and burden during long-term follow-up as assessed by ICM, with consequent reduction in hospitalizations and need to perform repeat ablation for AF.
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Romanov et al. (2018) conducted an RCT in pure typical atrial flutter (AFL) (n=50). CTI with concomitant PVI vs. CTI ablation alone was evaluated on occurrence of any atrial tachyarrhythmia with the monthly burden exceeding 0.5% on the ICM (reported as freedom from) (p=0.01). Prophylactic pulmonary vein isolation with CTI ablation in typical atrial flutter increased 3-year freedom from atrial tachyarrhythmia compared to CTI alone (48% vs 20%; P=0.01).
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