Key result
Adding unexcitability to pacing along the ablation line during PVI increased 12-month freedom from AF/AT compared with bidirectional block alone (82.7% vs 52%; p=0.001).
Why the study?
AF and AT recurrence is common after pulmonary vein isolation. This study evaluated whether an additional procedural endpoint of unexcitability to pacing along the ablation line reduces AF or AT recurrence after radiofrequency catheter ablation.
Does adding unexcitability to pacing along the ablation line as a procedural endpoint during pulmonary vein isolation improve freedom from atrial fibrillation or atrial tachycardia recurrence in patients with symptomatic paroxysmal atrial fibrillation?
RCT (n=102)
Yes
Does adding unexcitability to pacing along the ablation line as a procedural endpoint during pulmonary vein isolation improve freedom from atrial fibrillation or atrial tachycardia recurrence in patients with symptomatic paroxysmal atrial fibrillation?
Using pacing to ensure unexcitability along the pulmonary vein isolation ablation line significantly improves 12-month single-procedure freedom from atrial arrhythmia compared to demonstrating bidirectional block alone.
UE along the ablation line was associated with higher single-procedure success; leaves open whether this endpoint warrants routine adoption.
Objectives This study was conducted to determine if an additional procedural endpoint of unexcitability (UE) to pacing along the ablation line reduces recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) after radiofrequency catheter ablation. Background AF/AT recurrence is common after pulmonary vein isolation (PVI). Methods We included 102 patients from 2 centers (age 63 ± 10 years; 33 women; left atrium 38 ± 7 mm; left ventricular ejection fraction 61 ± 6%) with symptomatic paroxysmal AF. A 3-dimensional mapping system and circumferential mapping catheter were used in all patients for PVI. In group 1 (n = 50), the procedural endpoint was bidirectional block across the ablation line. In group 2 (n = 52), additional UE to bipolar pacing at an output of 10 mA and 2-ms pulse width was required. The primary endpoint was freedom from any AF/AT (>30 s) after discontinuation of antiarrhythmic drugs. Results Procedural endpoints were successfully achieved in all patients. Procedure duration was significantly longer in group 2 (185 ± 58 min vs. 139 ± 57 min; p < 0.001); however, fluoroscopy times were not different (23 ± 9 min vs. 23 ± 9 min; p = 0.49). After a follow-up of 12 months in all patients, 26 patients (52%) in group 1 versus 43 (82.7%) in group 2 were free from any AF/AT (p = 0.001) after a single procedure. No major complications occurred. Conclusions The use of pacing to ensure UE along the PVI line markedly improved near-term single-procedure success, compared with demonstration of bidirectional block alone. This additional endpoint significantly improved patient outcomes after PVI. (Unexcitability Along the Ablation as an Endpoint for Atrial Fibrillation Ablation; NCT01724437).
No takes yet. Share an insight, caveat, or question.
Steven et al. (2013) conducted an RCT in Symptomatic paroxysmal atrial fibrillation (n=102). Pulmonary vein isolation guided by bidirectional block plus unexcitability to bipolar pacing along the ablation line vs. Pulmonary vein isolation guided by bidirectional block alone was evaluated on Freedom from any AF/AT (>30 s) after discontinuation of antiarrhythmic drugs at 12 months (p=0.001). Adding unexcitability to pacing along the ablation line during PVI increased 12-month freedom from AF/AT compared with bidirectional block alone (82.7% vs 52%; p=0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: