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Does Electrogram Guided Substrate Ablation Add to the Success of Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation? A Prospective, Randomized Study
Author(s) -
DEISENHOFER ISABEL,
ESTNER HEIDI,
REENTS TILKO,
FICHTNER STEPHANIE,
BAUER AXEL,
WU JINJIN,
KOLB CHRISTOF,
ZRENNER BERNHARD,
SCHMITT CLAUS,
HESSLING GABRIELE
Publication year - 2009
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2008.01379.x
Subject(s) - medicine , pulmonary vein , sinus rhythm , cardiology , ablation , atrial fibrillation , catheter ablation , clinical endpoint , paroxysmal atrial fibrillation , randomized controlled trial
Pulmonary vein isolation (PVI) is an established treatment for paroxysmal atrial fibrillation (AF). The ablation of complex fractionated atrial electrograms (CFAE) has emerged as a novel treatment approach. We sought to evaluate the additional effect of CFAE ablation to PVI in paroxysmal AF.Methods and Results:Ninety‐eight patients with paroxysmal AF (57 ± 10 years, 74 male) were randomized to the PVI (n = 48) or PVI + CFAE group (n = 50). After PVI, CFAE ablation was performed in patients with inducible AF in the PVI + CFAE group. The primary endpoint was combined objective (7‐day Holter ECG) and subjective (symptoms) freedom of atrial tachyarrhythmia 3 months after ablation. Long‐term follow‐up (19 ± 8 months) was available in 94 of 98 patients. CFAE ablation was performed in 30 of 50 patients of the PVI + CFAE group. After 3 months, 36 of 48 patients (75%) in the PVI group and 38 of 50 patients (76%) in the PVI + CFAE group were in stable sinus rhythm (P = NS). During long‐term follow‐up (19 ± 8 months), 34 of 46 patients (74%) in the PVI group and 40 of 48 patients (83%) in the PVI + CFAE group were in sinus rhythm (P = 0.08). In a subgroup analysis, a significantly better long‐term outcome was achieved if inducible AF after PVI had been treated by additional CFAE ablation as compared with PVI only (sinus rhythm in 25/28 patients; 89% vs 22/30 patients 73%; P = 0.003).Conclusion:In the intention‐to‐treat analysis, additional CFAE ablation did not improve the success rate of PVI in patients with paroxysmal AF. However, during long‐term follow‐up, patients with still inducible AF after PVI seemed to profit from additional CFAE ablation.