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Article: Randomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation
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TitleRandomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation
 
AuthorsChen, M3
Yang, B3
Chen, H3
Ju, W3
Zhang, F3
Tse, HF2 1
Cao, K3
 
Keywordsatrial fibrillation
catheter ablation
complex fractionated electrograms
pulmonary veins
 
Issue Date2011
 
PublisherWiley-Blackwell Publishing, Inc.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=1045-3873
 
CitationJournal Of Cardiovascular Electrophysiology, 2011, v. 22 n. 9, p. 973-981 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1540-8167.2011.02051.x
 
AbstractCatheter Ablation of Paroxysmal AF. Introduction: Circumferential pulmonary vein antral isolation (PVAI) and atrial complex fractionated electrograms (CFEs) are both ablative techniques for the treatment of paroxysmal atrial fibrillation (PAF). However, data on the comparative value of these 2 ablation strategies are very limited. Methods and Results: We randomized 118 patients with drug-refractory PAF to receive PVAI ablation (n = 60) or CFE ablation (n = 58). For CFE group, spontaneous/induced AF was mapped using validated, automated software to guide ablation until all CFE areas were eliminated. For PVAI group, all 4 pulmonary vein antra were electrically isolated as confirmed by circular mapping catheter. Patients with spontaneous/inducible AF after the initial ablation procedure were crossed over to the other arms. After initial ablation procedure, AF persisted/inducible in 24/59 patients (41%), and 34/58 patients (59%) assigned to PVAI and CFE ablation, respectively (P = 0.05). Then 58 patients underwent PVAI + CFE ablation. After 22.6 ± 6.4 months, PVAI ablation group was more likely than CFE ablation group to achieve control of any AF/atrial tachycardia (AT) off drugs (43/60, 72% vs 33/58, 57%, P = 0.075) and lower recurrence rate of AT (11.9% vs 34.5%, P = 0.004). Patients who received CFE ablation alone (38%) had significantly lower overall success rate to achieve control of AF/AT off drugs compared with patients who received PVAI ablation (77%, P = 0.002) alone or PVAI + CFE ablation (69%, P = 0.008) due to higher recurrence rate of AT (50% vs 6% vs 13%, P < 0.01). Conclusions: CFE ablation in PAF patients was associated with higher occurrence rate of postprocedure AT compared with PVAI ablation, whereby making it less likely to be a sole ablation strategy for PAF patients. © 2011 Wiley Periodicals, Inc.
 
ISSN1045-3873
2012 Impact Factor: 3.475
2012 SCImago Journal Rankings: 1.816
 
DOIhttp://dx.doi.org/10.1111/j.1540-8167.2011.02051.x
 
ISI Accession Number IDWOS:000295131200004
Funding AgencyGrant Number
Provincial Natural Science of Jiangsu Province, ChinaBK2005218
Funding Information:

This work was supported by a grant from Provincial Natural Science of Jiangsu Province, China (BK2005218).

 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorChen, M
 
dc.contributor.authorYang, B
 
dc.contributor.authorChen, H
 
dc.contributor.authorJu, W
 
dc.contributor.authorZhang, F
 
dc.contributor.authorTse, HF
 
dc.contributor.authorCao, K
 
dc.date.accessioned2011-07-27T01:30:21Z
 
dc.date.available2011-07-27T01:30:21Z
 
dc.date.issued2011
 
dc.description.abstractCatheter Ablation of Paroxysmal AF. Introduction: Circumferential pulmonary vein antral isolation (PVAI) and atrial complex fractionated electrograms (CFEs) are both ablative techniques for the treatment of paroxysmal atrial fibrillation (PAF). However, data on the comparative value of these 2 ablation strategies are very limited. Methods and Results: We randomized 118 patients with drug-refractory PAF to receive PVAI ablation (n = 60) or CFE ablation (n = 58). For CFE group, spontaneous/induced AF was mapped using validated, automated software to guide ablation until all CFE areas were eliminated. For PVAI group, all 4 pulmonary vein antra were electrically isolated as confirmed by circular mapping catheter. Patients with spontaneous/inducible AF after the initial ablation procedure were crossed over to the other arms. After initial ablation procedure, AF persisted/inducible in 24/59 patients (41%), and 34/58 patients (59%) assigned to PVAI and CFE ablation, respectively (P = 0.05). Then 58 patients underwent PVAI + CFE ablation. After 22.6 ± 6.4 months, PVAI ablation group was more likely than CFE ablation group to achieve control of any AF/atrial tachycardia (AT) off drugs (43/60, 72% vs 33/58, 57%, P = 0.075) and lower recurrence rate of AT (11.9% vs 34.5%, P = 0.004). Patients who received CFE ablation alone (38%) had significantly lower overall success rate to achieve control of AF/AT off drugs compared with patients who received PVAI ablation (77%, P = 0.002) alone or PVAI + CFE ablation (69%, P = 0.008) due to higher recurrence rate of AT (50% vs 6% vs 13%, P < 0.01). Conclusions: CFE ablation in PAF patients was associated with higher occurrence rate of postprocedure AT compared with PVAI ablation, whereby making it less likely to be a sole ablation strategy for PAF patients. © 2011 Wiley Periodicals, Inc.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationJournal Of Cardiovascular Electrophysiology, 2011, v. 22 n. 9, p. 973-981 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1540-8167.2011.02051.x
 
dc.identifier.doihttp://dx.doi.org/10.1111/j.1540-8167.2011.02051.x
 
dc.identifier.epage981
 
dc.identifier.hkuros187308
 
dc.identifier.isiWOS:000295131200004
Funding AgencyGrant Number
Provincial Natural Science of Jiangsu Province, ChinaBK2005218
Funding Information:

This work was supported by a grant from Provincial Natural Science of Jiangsu Province, China (BK2005218).

 
dc.identifier.issn1045-3873
2012 Impact Factor: 3.475
2012 SCImago Journal Rankings: 1.816
 
dc.identifier.issue9
 
dc.identifier.openurl
 
dc.identifier.pmid21539635
 
dc.identifier.scopuseid_2-s2.0-80052837251
 
dc.identifier.spage973
 
dc.identifier.urihttp://hdl.handle.net/10722/135230
 
dc.identifier.volume22
 
dc.languageeng
 
dc.publisherWiley-Blackwell Publishing, Inc.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=1045-3873
 
dc.publisher.placeUnited States
 
dc.relation.ispartofJournal of Cardiovascular Electrophysiology
 
dc.relation.referencesReferences in Scopus
 
dc.rightsThe definitive version is available at www3.interscience.wiley.com
 
dc.subjectatrial fibrillation
 
dc.subjectcatheter ablation
 
dc.subjectcomplex fractionated electrograms
 
dc.subjectpulmonary veins
 
dc.titleRandomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation
 
dc.typeArticle
 
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<contributor.author>Chen, H</contributor.author>
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<contributor.author>Zhang, F</contributor.author>
<contributor.author>Tse, HF</contributor.author>
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Author Affiliations
  1. The University of Hong Kong Li Ka Shing Faculty of Medicine
  2. The University of Hong Kong
  3. Nanjing Medical University