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Catheter Versus Surgical Ablation of Atrial Fibrillation After a Failed Initial Pulmonary Vein Isolation Procedure: A Randomized Controlled Trial
Author(s) -
POKUSHALOV EVGENY,
ROMANOV ALEXANDER,
ELESIN DMITRY,
BOGACHEVPROKOPHIEV ALEXANDER,
LOSIK DENIS,
BAIRAMOVA SEVDA,
KARASKOV ALEXANDER,
STEINBERG JONATHAN S.
Publication year - 2013
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/jce.12245
Subject(s) - medicine , pulmonary vein , ablation , sinus rhythm , atrial fibrillation , catheter ablation , randomized controlled trial , clinical endpoint , adverse effect , catheter , surgery , cardiology , anesthesia , log rank test , survival analysis
Catheter Versus Surgical Ablation Introduction The aim of this prospective randomized study was to compare the efficacy and safety of catheter ablation (CA) versus surgical ablation (SA) in the treatment of paroxysmal and persistent AF after failed initial pulmonary vein isolation procedure. Methods and Results Patients with a history of symptomatic AF after a previous failed first ablation procedure were eligible for this study. Patients were randomized to CA (n = 32) or SA (n = 32) redo ablation. The primary endpoint was recurrence of atrial tachyarrhythmia at 1 year of follow‐up. At the 12‐month follow‐up, 26 (81%) of the 32 SA group patients and 15 (47%) of the 32 CA group were AF/AT‐free on no antiarrhythmic drugs (P = 0.004, log‐rank test). In patients with PAF, 17 (85%) patients of the 20 in SA group and 10 (56%) patients of the 18 in CA group were AF‐free (P = 0.04, log‐rank test). In patients with PersAF, 9 (75%) patients of the 12 in SA group and 5 (36%) patients of the 14 in CA group were AF‐free (P = 0.04, log‐rank test). The number of the serious adverse event in the SA group was significantly higher (1 CA group vs 7 SA group; P = 0.02). Conclusion In patients with PAF and PersAF after failed initial CA, SA is superior to CA for maintenance of sinus rhythm, although serious adverse event rate is significantly higher for SA.