Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Elimination of Nonpulmonary Vein Triggers Versus Noninducibility
- Authors
- Lee, Kwang-No; Roh, Seung-Young; Baek, Yong-Soo; Park, Hee-Soon; Ahn, Jinhee; Kim, Dong-Hyeok; Lee, Dae In; Shim, Jaemin; Choi, Jong-Il; Park, Sang-Weon; Kim, Young-Hoon
- Issue Date
- 2월-2018
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- atrial fibrillation; catheter ablation; incidence; recurrence; tachycardia
- Citation
- CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, v.11, no.2
- Indexed
- SCIE
SCOPUS
- Journal Title
- CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY
- Volume
- 11
- Number
- 2
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/77474
- DOI
- 10.1161/CIRCEP.117.005019
- ISSN
- 1941-3149
- Abstract
- BACKGROUND: Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. METHODS AND RESULTS: A total of 500 patients (mean age, 55.7 +/- 11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. CONCLUSIONS: Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.
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- Appears in
Collections - College of Medicine > Department of Medical Science > 1. Journal Articles
- Graduate School > Department of Biomedical Sciences > 1. Journal Articles
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