Repeat PVI with an additional left atrial anterior line did not improve the rate of stable sinus rhythm at 12 months compared to repeat PVI alone (50% vs 63%; P=0.26).
RCT (n=77)
randomized
Does repeat PVI with an additional left atrial anterior line improve stable sinus rhythm off antiarrhythmic medication compared to repeat PVI alone in patients with recurrent paroxysmal atrial fibrillation?
Adding a left atrial anterior line to repeat pulmonary vein isolation does not improve rhythm outcomes compared to repeat PVI alone in patients with recurrent paroxysmal atrial fibrillation.
Absolute Event Rate: 50% vs 63%
p-value: p=0.26
AIMS: In patients with paroxysmal atrial fibrillation (pAF), pulmonary vein isolation (PVI) has become an accepted treatment option with single procedure success rates of 60-80%. A repeat ablation is performed in ∼30% of patients because of arrhythmia recurrence. The strategy for this repeat procedure is not defined. METHODS AND RESULTS: Patients with pAF recurrence after PVI were prospectively randomized and underwent a second ablation procedure with either PVI of all reconnected veins or PVI with an additional left atrial anterior line. Follow-up in our arrhythmia clinic was every 3 months up to 12 months including 7 day Holter monitoring. A total of 77 patients (mean age 63 ± 9 years, 69% males) were included in the analysis. A repeat PVI was performed in 41 patients, PVI + anterior line in 36 patients. After a follow-up of 12 months, 26 of 41 (63%) patients after repeat PVI and 18 of 36 (50%) patients with PVI + anterior line were in stable sinus rhythm off antiarrhythmic medication (P = 0.26). In most patients (12 of 15 patients with PVI and 14 of 18 patients with PVI + anterior line) with an arrhythmia recurrence after the second procedure, the recurring arrhythmia was paroxysmal AF. In 2 of 15 patients of the PVI group and in 4 of 18 patients of the PVI + anterior line group atypical flutter was the reoccurring arrhythmia (P = NS). CONCLUSION: In this prospective randomized trial, patients with a recurrence of paroxysmal AF had no better outcome after repeat PVI + one left atrial line compared with patients with repeat PVI only.
Fichtner et al. (Wed,) conducted a rct in paroxysmal atrial fibrillation recurrence (n=77). PVI with an additional left atrial anterior line vs. repeat PVI of all reconnected veins was evaluated on stable sinus rhythm off antiarrhythmic medication (p=0.26). Repeat PVI with an additional left atrial anterior line did not improve the rate of stable sinus rhythm at 12 months compared to repeat PVI alone (50% vs 63%; P=0.26).