Abstract 10648: Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment After a Failed Initial Pulmonary Vein Isolation Procedure: A Randomized Study
Background: Catheter ablation (CA) and video-assisted thoracoscopic surgical ablation (SA) have become accepted therapy for symptomatic atrial fibrillation. The aim of this prospective randomized non-blind study was to compare the efficacy and safety of CA versus SA in the treatment of paroxysmal and persistent AF after failed initial pulmonary vein isolation procedure.
Methods and Results: Patients with a history of symptomatic AF (59% PAF and 41% PersAF) after a previous failed first RF ablation procedure were eligible for this study. Patients were randomized to CA (n=32) or SA (n=32) redo ablation. The primary end-point of the study was recurrence of atrial tachyarrhythmia, including AF and left atrial flutter/tachycardia, after a second ablation procedure at 1 year of follow-up. All patients were implanted with a cardiac monitor (Reveal XT, Medtronic) to continuously track the cardiac rhythm.
At the 12-month follow-up examination, 26 (81%) of the 32 SA group patients were AF/AT-free on no antiarrhythmic drugs. In contrast, in the CA group, only 15 (47%) of the 32 patients were AF/AT-free (p=0.004, Log-rank test). In patients with PAF, 17 (85%) patients of the 20 in SA group and 10 (56%) patients of the 18 in CA group were AF-free (p=0.04, log-rank test). In patients with Pers AF, 9 (75%) patients of the 12 in SA group and 5 (36%) patients of the 14 in CA group were AF-free (p=0.04, log-rank test). The total number of adverse events did not differ between the groups (9 CA group vs. 8 SA group; P=0.8).
Conclusion: In patients with paroxysmal and persistent AF after failed initial radiofrequency ablation, video-assisted thoracoscopic surgical ablation is superior to catheter ablation in maintenance of sinus rhythm. The adverse event rate is similar for both approaches.
- © 2013 by American Heart Association, Inc.