Pulmonary vein disconnection combined with a mitral isthmus line significantly improved the 1-year arrhythmia-free rate compared to PVD alone (71% vs 53%; P=0.01).
RCT (n=187)
Does pulmonary vein disconnection combined with mitral isthmus line ablation improve arrhythmia-free survival in patients with paroxysmal or persistent atrial fibrillation?
The addition of a mitral isthmus line to pulmonary vein disconnection significantly improves 1-year sinus rhythm maintenance in patients with atrial fibrillation, particularly those with persistent AF.
Absolute Event Rate: 71% vs 53%
p-value: p=0.01
BACKGROUND: The deployment of an ablation line connecting the left inferior PV to the mitral annulus (mitral isthmus line MIL) enhances the efficacy of pulmonary vein disconnection (PVD) in preventing atrial fibrillation (AF) recurrences. OBJECTIVES: To investigate the long-term effect of the additional linear lesion in a prospective randomized study. METHODS: One hundred and eighty-seven patients (37 females, mean age: 55 +/- 11 years) with paroxysmal (126) or persistent (61 patients) AF, were prospectively randomized into two groups: PVD (group A, 92 patients) or PVD combined with MIL (group B, 95 patients), performed by means of an irrigated-tip ablation catheter. RESULTS: Successful disconnection of all PVs was achieved in all patients. A bidirectional block (BB) along the left atrial isthmus was obtained in 72 of 95 (76%) patients in group B, most of whom required additional RF pulses from within the distal CS. A transient ischemic attack occurred in 1 patient of group A, and a cardiac tamponade occurred in 1 patient of group B. At 1 year, 53 +/- 5% (group A) and 71 +/- 5% (group B) remained arrhythmia free (P = 0.01); subgroup analysis highlights a higher improvement among patients with persistent AF (74 +/- 9% vs 36 +/- 9%; P < 0.01) than what was observed in paroxysmal AF (76 +/- 6% vs 62 +/- 6%; P < 0.05); antiarrhythmic drugs were continued in 56% and 50%, respectively, in groups A and B (P = ns). CONCLUSIONS: The addition of mitral isthmus line to the PV disconnection allows a significant improvement of sinus rhythm maintenance rate, particularly in patients with persistent AF, without the risk for major complications.
Fassini et al. (2005) conducted an RCT in Paroxysmal or persistent atrial fibrillation (n=187). Pulmonary vein disconnection combined with mitral isthmus line vs. Pulmonary vein disconnection alone was evaluated on Arrhythmia free at 1 year (p=0.01). Pulmonary vein disconnection combined with a mitral isthmus line significantly improved the 1-year arrhythmia-free rate compared to PVD alone (71% vs 53%; P=0.01).