Abstract 3317: Single Procedure Efficacy of Isolating All Versus Arrhythmogenic Pulmonary Veins on Long-Term Control of Atrial Fibrillation: A Prospective Randomized Study
Background: Electrical isolation (EI) of pulmonary veins (PV) is an effective therapy for atrial fibrillation (AF). Most centers now perform empiric EI of all PVs. However it is unclear if such an extensive ablation strategy is necessary. We hypothesized that EI of only arrhythmogenic PVs would be as efficacious as EI of all PVs in achieving long-term AF control.
Methods: Over a 20-month period, consenting patients (pts) were randomized to undergo AF ablation by targeting either arrhythmogenic or all PVs. We define arrhythmogenic PVs as veins initiating AF and/or atrial premature complexes spontaneously or with a standardized provocation protocol (up to 20ug/min isoproterenol infusion and cardioversion of pacing induced AF with and without isoproterenol). EI (using 4mm, 8mm, or cool tip) was guided by circular mapping catheter; the endpoint was entry and exit block persisting for ≥30 minutes. Pts were evaluated at 6 weeks, 6 months and 1 year with 3-weeks of transtelephonic monitoring that was done around at least 2 of the 3 visits and CT scan was performed at 3 months. Antiarrhythmic drugs (AAD) were routinely discontinued at 6 weeks. Long-term AF control (primary endpoint) was defined as complete freedom and/or >90% reduction in AF burden off or on previously ineffective AADs at 1year after a single ablation procedure. Bivariate analyses and multivariable logistic regression models were used to compare and determine potential predictors of primary endpoint.
Results: Study cohort included 105 pts (age 57±9 years, 82 males) of which 98 pts completed the 1-year follow-up. EI was achieved in 99% of targeted PVs. Please see table⇓ for details.
Conclusion: In a randomized comparison, EI of arrhythmogenic PVs was as efficacious as EI of all PVs in achieving long-term AF control after a single ablation procedure (OR 1.22; 95% CI 0.50, 2.94; p=0.66). There was no significant difference in procedure time or complication rates between the two techniques.