What question did this study set out to answer?

To compare the safety, efficacy, and procedural characteristics of anterior versus posterior approaches for atrioventricular junction modification in medically refractory atrial fibrillation.

June 1, 2000Pacing and Clinical Electrophysiology

A Randomized, Prospective Comparison of Anterior and Posterior Approaches to Atrioventricular Junction Modification of Medically Refractory Atrial Fibrillation

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Why the study?

Does an anterior approach improve primary success compared to a posterior approach for AV junction modification in patients with medically refractory atrial fibrillation?

Population

40 patients with medically refractory paroxysmal (PAF) or chronic atrial fibrillation (AF)

Comparison

Atrioventricular junction modification using an… vs Atrioventricular junction modification using a…

Design

RCT, randomly assigned

Authors

SLShih‐Huang LeeNational Synchrotron Radiation Research Center JCJun-Jack ChengFu Jen Catholic University SCShih‐Ann ChenElectrophysiology

Discussion

Member takes

Implication

Similar success supports either approach for AV junction modification in refractory AF; anterior extends evidence by shortening procedural and fluoroscopy times.

Key Points

To compare the safety, efficacy, and procedural characteristics of anterior versus posterior approaches for atrioventricular junction modification in medically refractory atrial fibrillation.
Randomized prospective trial of 40 patients with drug-refractory paroxysmal or chronic atrial fibrillation assigned to an anterior approach (n=18) or posterior approach (n=22).
Patients crossed over to the alternative ablation technique if the initial approach did not achieve success within one hour.
Primary success rates (14/18 [78%] anterior vs 14/22 [64%] posterior, P = NS), transient AV block (3/18 vs 3/22, P = NS), and complete AV block (1/18 [5%] vs 1/22 [4%], P = NS) did not differ significantly between groups.
Successful posterior approaches required significantly more radiofrequency pulses (10 ± 4 vs 6 ± 3 pulses, P < 0.01), longer procedural duration (50 ± 24 vs 28 ± 18 minutes, P < 0.01), and longer fluoroscopy exposure (28 ± 17 vs 16 ± 8 minutes, P < 0.01).
Crossover to the alternative approach successfully resolved all remaining cases (3 of 3 anterior failures and 7 of 7 posterior failures).

Structured PICO

Does an anterior approach improve primary success compared to a posterior approach for AV junction modification in patients with medically refractory atrial fibrillation?

Population

40 patients with medically refractory paroxysmal (PAF) or chronic atrial fibrillation (AF)

Intervention

Atrioventricular (AV) junction modification using an anterior approach

Comparator

Atrioventricular (AV) junction modification using a posterior approach

Outcome

Primary success rate

Anterior and posterior approaches for AV junction modification have similar efficacy, but the posterior approach requires more radiofrequency pulses and longer procedural and fluoroscopy times.

Cite This Study

Lee et al. (2000) studied this question.

synapsesocial.com/papers/6a768cf88165d49cffcfef82 https://doi.org/10.1111/j.1540-8159.2000.tb00882.x

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Implication

Similar success supports either approach for AV junction modification in refractory AF; anterior extends evidence by shortening procedural and fluoroscopy times.

A Randomized, Prospective Comparison of Anterior and Posterior Approaches to Atrioventricular Junction Modification of Medically Refractory Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

A Randomized, Prospective Comparison of Anterior and Posterior Approaches to Atrioventricular Junction Modification of Medically Refractory Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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