Open AccessA Prospective Randomized Study Comparing Isolation of the Arrhythmogenic Vein Versus All Veins in Paroxysmal Atrial Fibrillation
Author(s) -
Fichtner Stephanie,
Hessling Gabriele,
Ammar Sonia,
Reents Tilko,
Estner Heidi L.,
Jilek Clemens,
Kathan Susanne,
Büchner Michael,
Dillier Roger,
Deisenhofer Isabel
Publication year - 2013
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22132
Subject(s) - medicine , atrial fibrillation , pulmonary vein , cardiology , atrial tachycardia , sinus rhythm , catheter ablation , ablation , implantable loop recorder , tachycardia , paroxysmal atrial fibrillation , randomized controlled trial , electrocardiography , prospective cohort study , anesthesia
Background Ablation procedures in patients with paroxysmal atrial fibrillation ( PAF ) includes isolation of all pulmonary veins ( PVs ). We hypothesized that an approach using an algorithm to detect arrhythmogenic PVs ( aPVs ) might lead to shorter procedure duration ( PD ) and fewer proarrhythmic effects ( PE ). Hypothesis Isolation of the aPVs only leads to a reduced PD , reduced PEs , and fewer adverse events, with a success rate comparable to the standard all‐ PV approach. Methods In this prospective trial, 207 patients with PAF were randomized to undergo isolation of the aPV ( AG group, n = 105) or isolation of all PVs ( VG group, n = 102). The aPV was identified by atrial fibrillation (AF) induction, focal discharge, or short local PV decremental conduction during PV pacing. Patients were followed with repetitive 7‐day Holter electrocardiograms ( ECGs ) after 3, 6, and 12 months in our arrhythmia clinic. Results In 97% of patients, at least 1 aPV was identified (mean, 2.1). PD did not differ significantly (152.3 ± 57.1 minutes vs 162 ± 68 minutes, P = 0.27) between the groups, but the number of radiofrequency ( RF ) applications and fluoroscopy time ( FT ) and dose were significantly lower in the AG group than in the VG group. The occurrence of PE (new‐onset atrial tachycardia) and adverse events ( AE ) did not differ between the 2 groups ( P = 0.1). Sinus rhythm off antiarrhythmic medication (documented on 7‐day Holter ECGs ) 12 months after a single procedure was achieved in 53% in the AG group and 59% in the VG group ( P = 0.51). Conclusions Isolation of the aPVs detected by a straightforward algorithm leads to similar success rates compared to a standard all‐ PV approach with regard to PD , AE , or PE and is associated with less RF and a shorter FT .