Abstract 2884: Circumferential Pulmonary Vein Ablation versus Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation. A Long-term Randomized Trial (APAF-study)
Background: Circumferential pulmonary vein ablation (CPVA) has been safely and effectively applied for curing paroxysmal atrial fibrillation (AF); however, its safety and efficacy, as compared with that of antiarrhythmic drug therapy (ADT), have never been formally assessed in a randomized controlled fashion.
Methods: One hundred ninety-eight patients (age, 56±10 years) with paroxysmal AF (duration, 6±5 years, mean AF paroxysms 3.4/month), were randomized to CPVA or to ADT with flecainide, sotalol or amiodarone. Ablation was randomly performed with the use of a standard or an irrigated tip catheter and with the guidance of CARTO or NavX non fluoroscopic 3D systems. Cardiac rhythm was assessed with daily transtelephonic transmissions over a 12 month follow-up. Crossovers were permitted after 3 months.
Results: At 1 year, 91% of patients in the CPVA group and 35% in the control group were free from recurrent atrial arrhythmias (P<0.001); a repeat ablation was performed in 11% of patients in the CPVA group for recurrent AF (8%) or atypical atrial flutter (3%). A lower EF, hypertensive cardiomyopathy and age independently predicted AF recurrences in the AAD group. CPVA was associated with a significant decrease in left atrial diameter (15±10%, P<0.01) and with a fewer number of cardiovascular hospitalizations (p<0.01). Ablation with an irrigated tip catheter was more effective (P=0.03) with either the CARTO or NavX system (P=0.08). One TIA and one pericardial effusion occurred in the CPVA group; side effects of ADT were reported in 23 patients.
Conclusions: Paroxysmal AF can be cured long-term in >90% of patients by means of CPVA.