Key result
Wide circumferential pulmonary vein isolation using the endoscopic ablation system was feasible in only 11% to 54% of veins, whereas individual isolation achieved high first-pass success rates.
Why the study?
Does wide circumferential PVI compared to individual PVI improve procedural success using the endoscopic ablation system in patients with atrial fibrillation?
RCT (n=38)
Does wide circumferential PVI compared to individual PVI improve procedural success using the endoscopic ablation system in patients with atrial fibrillation?
Separate isolation of individual pulmonary veins is more feasible and should be the preferred strategy over wide circumferential isolation when using the endoscopic ablation system for atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Individual PVI may be favored over wide circumferential isolation with the endoscopic system; leaves open optimal strategy pending randomized confirmation.
INTRODUCTION: The endoscopic ablation system (EAS) allows for effective pulmonary vein isolation (PVI). The feasibility of wide circumferential as compared to individual PVI using the EAS has not been formally assessed. METHODS: Patients with paroxysmal or short-persistent atrial fibrillation were assigned to individual PVI (group A) or wide circumferential PVI (group B). In group B, circumferential PVI was attempted only if the ipsilateral inferior PV was visualized while the ablation system targeted the superior PV and vice versa. Otherwise, individual PVI was performed. RESULTS: A total of 38 patients were enrolled (Group A: 20 patients, age 61 ± 7 years, LA-diameter 43 ± 5 mm; Group B: 18 patients, age 62 ± 10 years, LA-diameter 43 ± 4 mm). In group A, 20/20 (100%) right superior (RSPV) and inferior (RIPV) PVs, 18/19 (95%) left superior (LSPV) and inferior (LIPV) PVs, and 1/1 (100%) left common ostium (LCPV) were successfully isolated. First-pass success rate was 95%, 85%, 68%, and 95% for the RSPV, RIPV, LSPV, and LIPV, respectively. Touch-up radiofrequency ablation was required in 1/19 (5%) LSPV and LIPV. In group B, an attempt at circumferential PVI was feasible in 2/18 (11%) septal PVs and successful on first pass. Lateral circumferential PVI was attempted and successful on first-pass in 7/13 (54%) LSPVs and LIPVs and 1/5 (20%) LCPVs. CONCLUSIONS: Using the EAS in patients with AF, separate isolation of individual PVs rather than wide circumferential PVI should be the preferred ablation strategy.
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Wißner et al. (2013) conducted an RCT in Paroxysmal or short-persistent atrial fibrillation (n=38). Wide circumferential pulmonary vein isolation using the endoscopic ablation system vs. Individual pulmonary vein isolation was evaluated on Feasibility and first-pass success rate of pulmonary vein isolation. Wide circumferential pulmonary vein isolation using the endoscopic ablation system was feasible in only 11% to 54% of veins, whereas individual isolation achieved high first-pass success rates.
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