Abstract 16385: Additional Linear Ablation After Circumferential Pulmonary Vein Isolation Does Not Reduce Clinical Recurrence in Patients With Paroxysmal Atrial Fibrillation: Prospective Randomized Study
Background & objectives: Circumferential pulmonary vein isolation(CPVI) has been considered as the cornerstone forradiofrequency catheter ablation (RFCA) of paroxysmal Atrial fibrillation(PAF). However, it is not clear whether linear ablation in addition to CPVI is effective in patients with PAF. We conducted prospective randomized study to evaluate whether the additional linear ablation with roof line, posterior box lesion or LA anterior wall ablation to circumferential pulmonary vein isolation(CPVI) improves clinical outcome of PAF ablation.
METHODS: This study enrolled 255 PAF patients(male 77.5%, 56.1±11.4 years old) who underwent RFCA, and randomly assigned CPVI (n=102), CPVI + roof line(CPVI+RL; n=52), CPVI + RL + posterior inferior line(CPVI+PostBox; n=52) and CPVI + PostBox + LA anterior wall ablation(CPVI+PostBox+LAAW; n=49) groups.
RESULTS: 1. CPVI showed shorter total procedure time (170.86±36.40 min vs 189.62±28.95 min vs 201.69±51.69 min vs 192.53±43.99 min, p<0.001) and ablation time (4056.9±1158.5 sec vs 5253.5±1010.9 sec vs 5495.0±1316.0 sec vs 5431.71±1577.6 sec, p<0.001) than CPVI+RL, CPVI+PostBox and CPVI+PostBox+LAAW. 2. During 24.8±6.8 month follow-up, the clinical recurrence rates were 20.6% in CPVI, 34.6% in CPVI+RL, 26.9% in CPVI+PostBox and 26.5% in CPVI+PostBox+LAAW group(p=0.308). 3. The achievement rate of CPVI was 100.0%, and bidirectional block rate was 80.8% in CPVI+RL, 59.6% in CPVI+PostBox and 67.3% in CPVI+PostBox+LAAW. The clinical recurrence rates with or without achieving bidirectional block were not significantly different from each other. 4. Complication rates were 3.9% in CPVI, 1.9% in CPVI+RL, 5.8% in CPVI+PostBox and 0% in CPVI+PostBox+LAAW(p=0.357).
CONCLUSION: In spite of prolonged ablation time, additional linear ablation such as RL, PostBox or PostBox+LAAW did not improve clinical outcome of RFCA in PAF patients, compared with CPVI only group.
- © 2013 by American Heart Association, Inc.