A Randomized Controlled Trial of the Efficacy and Safety of Electroanatomic Circumferential Pulmonary Vein Ablation Supplemented by Ablation of Complex Fractionated Atrial Electrograms Versus Potential-Guided Pulmonary Vein Antrum Isolation Guided by Intracardiac Ultrasound

Khaykin, Yaariv; Skanes, Allan C.; Champagne, Jean; Themistoclakis, Sakis; Gula, Lorne J.; Rossillo, Antonio; Bonso, Aldo; Raviele, Antonio; Morillo, Carlos A.; Wulffhart, Zaev; Martin, David O.

doi:10.1161/circep.109.848978

Cited by 49 publications

(56 citation statements)

References 32 publications

(29 reference statements)

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“…After a mean follow-up of 24 ± 12 months, antral PVI was more likely to achieve control of atrial tachyarrhythmias off antiarrhythmic drugs (57% vs. 27%, P = 0.02). 16 Similar results were shown by Karch et al in a study that randomized 100 patients to circumferential PV ablation or segmental PVI guided by a circular mapping catheter.…”

Section: Techniques and Outcomes Of Pvisupporting

confidence: 78%

“…6,[8][9][10] Wide antral PV isolation guided by recordings from a circular mapping catheter has been demonstrated superior to other ablation techniques in studies of direct comparison. 6,16 Circumferential PV ablation guided by nonfluoroscopic electroanatomic mapping systems, without confirmation of electrical isolation with a circular mapping catheter, has been demonstrated ineffective in achieving long-term arrhythmia control. 7,16 In a randomized comparison between CARTO ® -guided circumferential PV ablation (Biosense Webster, Inc., Diamond Bar, CA) and PV antrum isolation with ICE and a circular mapping catheter, 16 Khaykin et al studied 60 patients with drug-refractory AF with the end point of long-term procedural success defined as the absence of atrial tachyarrhythmias off antiarrhythmic drugs.…”

Section: Techniques and Outcomes Of Pvimentioning

confidence: 99%

“…6,16 Circumferential PV ablation guided by nonfluoroscopic electroanatomic mapping systems, without confirmation of electrical isolation with a circular mapping catheter, has been demonstrated ineffective in achieving long-term arrhythmia control. 7,16 In a randomized comparison between CARTO ® -guided circumferential PV ablation (Biosense Webster, Inc., Diamond Bar, CA) and PV antrum isolation with ICE and a circular mapping catheter, 16 Khaykin et al studied 60 patients with drug-refractory AF with the end point of long-term procedural success defined as the absence of atrial tachyarrhythmias off antiarrhythmic drugs. After a mean follow-up of 24 ± 12 months, antral PVI was more likely to achieve control of atrial tachyarrhythmias off antiarrhythmic drugs (57% vs. 27%, P = 0.02).…”

Section: Techniques and Outcomes Of Pvimentioning

confidence: 99%

See 2 more Smart Citations

Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation?

Lin¹

2015

Methodist DeBakey Cardiovascular Journal

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Section: Techniques and Outcomes Of Pvisupporting

confidence: 78%

Section: Techniques and Outcomes Of Pvimentioning

confidence: 99%

Section: Techniques and Outcomes Of Pvimentioning

confidence: 99%

See 1 more Smart Citation

Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation?

Lin¹

2015

Methodist DeBakey Cardiovascular Journal

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“…26,27 Previous studies have reported significantly better outcome with PVAI guided by circular mapping catheter over 3D mapping-guided circumferential PV isolation. 28,29 Also, in a meta-analysis by Proietti et al, wideantral approach encompassing the part of the posterior wall in between the PVs was observed to be more effective than ostial PV isolation in achieving freedom from arrhythmia. 30 For Shah et al, 14 the recurrence rate at 1, 2, 3, 4, and 5 years of follow-up were 8.7%, 5.8%, 8.8%, 13%, and 25.5%.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results-A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions-In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers. (Circ Arrhythm Electrophysiol. 2016;9:e003660.

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“…Several randomized controlled trials (RCTs) have demonstrated superior results for restoration of normal sinus rhythm with catheter ablation compared with antiarrhythmic drug therapy, despite some patients requiring multiple ablation procedures (84)(85)(86)(87)(88). When catheter ablation is used in combination with antiarrhythmic drug therapy, the success rate of achieving normal sinus rhythm was 71% [95% confidence interval (CI), 65-77%], which is superior to antiarrhythmic drug therapy alone at 57% (95% CI, 50-64%) (88).…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation: review of current treatment strategies

Xu¹,

Luc²,

Phan³

2016

J. Thorac. Dis.

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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.

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A Randomized Controlled Trial of the Efficacy and Safety of Electroanatomic Circumferential Pulmonary Vein Ablation Supplemented by Ablation of Complex Fractionated Atrial Electrograms Versus Potential-Guided Pulmonary Vein Antrum Isolation Guided by Intracardiac Ultrasound

Cited by 49 publications

References 32 publications

Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation?

Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation?

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Atrial fibrillation: review of current treatment strategies

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