Key result
PV antrum radial-linear ablation cuts AF recurrence ~69% versus encircling PV isolation.
Why the study?
Does pulmonary vein antrum radial-linear ablation reduce recurrence of atrial fibrillation compared to encircling pulmonary vein isolation in patients with paroxysmal atrial fibrillation?
RCT (n=86)
randomly assigned
Does pulmonary vein antrum radial-linear ablation reduce recurrence of atrial fibrillation compared to encircling pulmonary vein isolation in patients with paroxysmal atrial fibrillation?
Hazard Ratio: 0.31 (95% CI 0.12–0.78)
Absolute Event Rate: 74% vs 50%
p-value: p=0.013
Pulmonary vein antrum radial-linear ablation significantly reduced atrial fibrillation recurrence and procedure times compared to standard encircling pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
Supports radial-linear ablation for paroxysmal AF; extends randomized ablation strategy comparisons.
BACKGROUND: Substrate abnormality in pulmonary vein (PV) antrum plays a critical role in mechanism of atrial fibrillation (AF). The present study compares the strategy of PV antrum radial-linear (PAR) ablation to encircling PV isolation for paroxysmal AF. METHODS AND RESULTS: A total of 86 patients with paroxysmal AF were randomly assigned to PAR ablation group or PV isolation group. The average procedure time was 161±21 minutes in PAR ablation group and 199±39 minutes in PV isolation group (P<0.01). The average fluoroscopy time was 25±5 minutes in PAR ablation group and 32±9 minutes in PV isolation group (P<0.001). At 14 (15-12) months of follow-up after single procedure, 31 of 42 (74%) patients in PAR ablation group and 22 of 44 patients (50%) in PV isolation group had no recurrence of AF off antiarrhythmic drug (P=0.0249); and 36 of 42 patients (86%) in PAR ablation group and 26 of 44 patients (59%) in PV isolation group had no recurrence of AF with antiarrhythmic drug (P=0.006). In addition, PAR ablation resulted in greater reduction of left atrial diameter than encircling PV isolation. Multivariable Cox regression analysis showed that only ablation strategy was independently associated with AF recurrence (hazard ratio, 0.31; 95% confidence interval, 0.12-0.78; P=0.013). No major adverse event related to the procedures occurred. CONCLUSIONS: This study suggests that PAR ablation is a potentially effective strategy for treatment of paroxysmal AF warranting further investigation. CLINICAL TRIAL REGISTRATION: URL: http://www.chictr.org; Unique identifier: ChiCTR-TRC-11001191.
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Zhao et al. (2013) conducted an RCT in Paroxysmal atrial fibrillation (n=86). Pulmonary vein antrum radial-linear (PAR) ablation vs. Encircling PV isolation was evaluated on No recurrence of AF off antiarrhythmic drug (HR 0.31, 95% CI 0.12-0.78, p=0.013). Pulmonary vein antrum radial-linear ablation significantly reduced the risk of atrial fibrillation recurrence compared to encircling PV isolation (HR 0.31; 95% CI 0.12-0.78; P=0.013).
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