PVI plus left linear lesions was superior to PVI alone in maintaining sinus rhythm without antiarrhythmic drugs after a second procedure in paroxysmal (85% vs 62%) and persistent AF (75% vs 39%).
RCT (n=204)
Does PVI plus left linear lesions improve maintenance of sinus rhythm compared to PVI alone in patients with paroxysmal or persistent/permanent atrial fibrillation?
PVI plus left linear lesions is superior to PVI alone for long-term maintenance of sinus rhythm without antiarrhythmic drugs in patients with paroxysmal and persistent atrial fibrillation.
Background— Data regarding the long-term efficacy of atrial fibrillation (AF) ablation are still lacking. Methods and Results— Two hundred four consecutive patients symptomatic for paroxysmal or persistent/permanent AF were randomly assigned to 2 different ablation schemes: pulmonary vein isolation (PVI) and PVI plus left linear lesions (LL). Primary end point was to assess the maintenance of sinus rhythm (SR) after procedures 1 and 2 in the absence of antiarrhythmic drugs in a long-term follow-up of at least 3 years. Paroxysmal AF— With a single procedure at 12-month follow-up, 46% of patients treated with PVI maintained SR, whereas at 3-year follow-up, 29% were in SR; using the “PVI plus LL” at the 12-month follow-up, 57% of patients were in SR, whereas at the 3-year follow-up, 53% remained in SR. After a second procedure, the long-term overall success rate without antiarrhythmic drugs was 62% with PVI and 85% with PVI plus LL. Persistent/Permanent AF— With a single procedure at the 12-month follow-up, 27% of patients treated with PVI were in SR, whereas at the 3-year follow-up, 19% maintained SR; using the PVI plus LL with a single procedure at the 12-month follow-up 45% of patients were in SR, whereas at the 3-year follow-up, 41% remained in SR. After a second procedure, the long-term overall success rate without antiarrhythmic drugs was 39% with PVI and 75% with PVI plus LL. Conclusions— A long-term follow-up of AF ablation shows that short-term results cannot be considered permanent because AF recurrences are still present after the first year especially in patients who have had “PVI” strategy. PVI isolation plus LL is superior to the PVI strategy in maintaining SR without antiarrhythmic drugs after procedures 1 and 2 both in paroxysmal and persistent AF.
Gaïta et al. (2008) conducted an RCT in Paroxysmal or persistent/permanent atrial fibrillation (n=204). Pulmonary vein isolation (PVI) plus left linear lesions (LL) vs. Pulmonary vein isolation (PVI) was evaluated on Maintenance of sinus rhythm (SR) after procedures 1 and 2 in the absence of antiarrhythmic drugs in a long-term follow-up of at least 3 years. PVI plus left linear lesions was superior to PVI alone in maintaining sinus rhythm without antiarrhythmic drugs after a second procedure in paroxysmal (85% vs 62%) and persistent AF (75% vs 39%).