Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: Three‐year outcomes of the PREVENT AF I study

Abstract

Prophylactic PVI in patients with only typical AFL resulted in a significant reduction of new-onset AF and burden during long-term follow-up as assessed by ICM, with consequent reduction in hospitalizations and need to perform repeat ablation for AF.

Prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation for atrial flutter: A meta‐analysis

“…A separate analysis was performed to determine the effect of the combined procedure at 2 years. Long‐term outcomes of the PREVENT AF study were recently published, and these data were used for the 2‐year analysis. CTI alone was associated with nearly a 2‐fold increase risk of recurrent AA at 2 years (1.94 [1.16, 3.23] 95% CI, P = 0.01, Figure ).…”

“…Interestingly, there was a difference in the proportion of patients developing AA between years 1 and 2. Data from the two studies reporting a minimum 2‐year follow‐up, revealed that 18.8% of patients in the CTI plus PVI group developed AF between years 1 and 2, compared to 11.3% in the CTI‐only group. This may represent a proarrhythmic effect of PVI with development of left atrial macroreentrant atrial tachycardias associated with the ablation procedure.…”

“…Despite the higher increase in AA in year 2 in CTI plus PVI, this group still had significantly less recurrent AA at the end of the 2‐year follow‐up period. In the 3‐year outcomes of the PREVENT AF study, Romanov et al reported a significant increase in recurrent AA at 3 years with CTI alone (80% vs 52%, P = 0.01) . In addition, they found a significant decrease in AF burden with CTI plus PVI compared to CTI alone (6.2% vs 16.8%, P = 0.03).…”

“…Romanov et al recently reported an overall less cost and procedural risk with a combined ablation. This was driven by a higher recurrent AA at 3 years with CTI alone (80%), in addition to a significantly higher rate of repeat procedures and hospitalizations with CTI alone . Furthermore, in the present study, no significant difference in major complications requiring intervention was observed with the combined procedures.…”

Have we reached the point of primary prevention for atrial fibrillation?

“…These issues are explored in an important study in this issue of the journal by Romanov et al . These investigators present the 3‐year outcomes of the PREVENT AF I Study, which enrolled patients with typical cavotricuspid isthmus (CTI)‐dependent atrial flutter (AFL), without any prior history of atrial fibrillation (AF).…”