Controversy: Circumferential versus segmental pulmonary vein isolation/segmental PVI

Feld, Gregory K.

doi:10.1002/9781118658369.ch13b

Cited by 1 publication

(4 citation statements)

References 32 publications

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“…segmental vs. circumferential) to achieve durable PVI and ensure long-term success in preventing recurrence of AF. In fact, there is no definitive prospective randomized study published to date, with a large enough population of patients, over an acceptable duration of follow-up, and with adequate monitoring to ensure identification of AF recurrence, which convincingly proves one method as being superior to achieve durable PVI and long-term suppression of AF [17].…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the total procedure duration was significantly longer in the circumferential group than that in the segmental PVI group, (mean difference, 17.22 min 95% CI, 11.09-23.34), whereas the total fluoroscopy time was significantly reduced, mean difference, −9.25 min (95% CI, −10.50-−8.01). Radiofrequency application time was reported in Perez-Lugones et al [9], Mansour et al [21], Oral et al [23], Nilsson et al [24], Liu et al [26], Arentz et al [27], Jin Hwang et al [28], Sawhney et al [31], Tan et al [30], Yamane et al [32] studies. The circumferential group had longer times mean difference, 11.87 min (95% CI, 10.45-13.30 min).…”

Section: Procedures Time Fluoroscopic Time Mapping Time and Rf Ablamentioning

confidence: 93%

“…In large meta-analysis comparing between circumferential and segmental ablation, published in 2014 [25], data on total procedure duration and fluoroscopy time were reported in Calkins et al [8], [22], [26], [27], [28], [29], [30], and [10], [21], [23], [24], [26], [27], [28], [31], [22], [30], [32] studies, respectively.…”

Section: Procedures Time Fluoroscopic Time Mapping Time and Rf Ablamentioning

confidence: 99%

“…In a meta-analysis published by Proietti et al [25], they analyzed seven studies [23], [24], [26], [27], [30], [31], [32]s that assessed atrial tachycardia recurrence as a separate outcome. A trend toward a higher incidence of LA tachycardia occurrence in the WACA group was detected, which did not reach statistical significance (OR, 1.53; 95% CI, 0.88-2.69; p = 0.13) although AF recurrence was lower.…”

Section: Post-af Ablation Atrial Tachyarrhythmiamentioning

confidence: 99%

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Segmental Versus Circumferential Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

Wedn¹,

El-Damaty²,

Elhalag³

et al. 2020

Open Access Maced J Med Sci

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INTRODUCTION: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation techniques for the treatment of paroxysmal atrial fibrillation (PAF), with significantly improved efficacy compared to antiarrhythmic drugs as shown in CABANA trial. However, the question arises in which PAF patients whether the procedure can be limited to PVs only showing potentials (segmental), or it is really necessary to isolate all PV (circumferential). Even though success rates for circumferential PV ablation (CPVA) have been reported to be higher (up to 90%), than segmental PV ablation, most CPVA procedures previously reported included left atrial linear ablation, additional ablation lesions or lines connecting the mitral valve to the posterior PVs or along the roof of the left atrium which made bias to these studies. AIM: Thus, we initiated this randomized controlled study to evaluate the efficacy of CPVA versus SPVI in subjects undergoing ablation of PAF. METHODS: Our study included 31 consecutive patients who underwent their first radiofrequency ablation for PAF between March 2015 and March 2017. Patients were randomized for circumferential or segmental ablation on the day of the procedure. We had two groups, circumferential (17 patients) and segmental group (14 patients). RESULTS: There was no difference between two groups on our primary endpoint, the recurrence, which was 2 out of 14 patients (14.3%) in the segmental ablation group, compared to 3 out of 17 patients (17.6%) who were circumferential ablated. This difference is statistically insignificant (p = 1). For other endpoints, there was also no statistically significant difference between circumferential and segmental regarding fluoroscopy time, 53.47 ± 8.7 min versus 54.93 ± 15.02 min, p = 0.738, procedure time, 184.18 ±19.28 min versus 191.43 ± 20 min p = 0.315, and even for radio frequency time which was lower in segmental group but did not differ statistically, 35.71 ± 5.73 min versus 34.79 ± 5.29, min p = 0.649. CONCLUSION: The previous studies showed the superiority of circumferential PVI on segmental strategy regarding effectiveness, but in those studies, linear ablations were added to circumferential strategy and done in cases of persistent and PAF. In our randomized study, we compared between two methods in cases of PAF, which showed that segmental ablation is not inferior to circumferential ablation of PVI.

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Section: Discussionmentioning

confidence: 99%

Section: Procedures Time Fluoroscopic Time Mapping Time and Rf Ablamentioning

confidence: 93%

Section: Procedures Time Fluoroscopic Time Mapping Time and Rf Ablamentioning

confidence: 99%

Section: Post-af Ablation Atrial Tachyarrhythmiamentioning

confidence: 99%

See 2 more Smart Citations

Segmental Versus Circumferential Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

Wedn¹,

El-Damaty²,

Elhalag³

et al. 2020

Open Access Maced J Med Sci

View full text Add to dashboard Cite

show abstract

Controversy: Circumferential versus segmental pulmonary vein isolation/segmental PVI

Cited by 1 publication

References 32 publications

Segmental Versus Circumferential Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

Segmental Versus Circumferential Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

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