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Atrial Fibrillation Ablation Strategies for Paroxysmal Patients

2009; Lippincott Williams & Wilkins; Volume: 2; Issue: 2 Linguagem: Inglês

10.1161/circep.108.798447

1941-3149

Luigi Di Biase, Claude S. Elayi, Tamer S. Fahmy, David O. Martin, Chi Keong Ching, Conor D. Barrett, Rong Bai, Dimpi Patel, Yaariv Khaykin, Richard Hongo, Steven Hao, Salwa Beheiry, Gemma Pelargonio, Antonio Dello Russo, Michela Casella, P Santarelli, Domenico Potenza, Raffaele Fanelli, Raimondo Massaro, Paul J. Wang, Amin Al‐Ahmad, Maurício Arruda, Sakis Themistoclakis, Aldo Bonso, Antonio Rossillo, Antonio Raviele, Robert A. Schweikert, David Burkhardt, Andrea Natale,

Cardiac electrophysiology and arrhythmias

Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF.One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAEs group (P<0.001) after a single procedure and with antiarrhythmic drugs.No difference in terms of success rate was seen between PVAI alone and PVAI associated with defragmentation. CFAEs ablation alone had the smallest impact on AF recurrences at 1-year follow-up. These results suggest that antral isolation is sufficient to treat most patients with paroxysmal AF.