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Article: Randomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation

TitleRandomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation
Authors
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
Citation
Journal Of Cardiovascular Electrophysiology, 2011, v. 22 n. 9, p. 973-981 How to Cite?
Abstract
Catheter 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.
Persistent Identifierhttp://hdl.handle.net/10722/135230
ISSN
2013 Impact Factor: 2.881
ISI Accession Number ID
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).

References

 

DC FieldValueLanguage
dc.contributor.authorChen, Men_HK
dc.contributor.authorYang, Ben_HK
dc.contributor.authorChen, Hen_HK
dc.contributor.authorJu, Wen_HK
dc.contributor.authorZhang, Fen_HK
dc.contributor.authorTse, HFen_HK
dc.contributor.authorCao, Ken_HK
dc.date.accessioned2011-07-27T01:30:21Z-
dc.date.available2011-07-27T01:30:21Z-
dc.date.issued2011en_HK
dc.identifier.citationJournal Of Cardiovascular Electrophysiology, 2011, v. 22 n. 9, p. 973-981en_HK
dc.identifier.issn1045-3873en_HK
dc.identifier.urihttp://hdl.handle.net/10722/135230-
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.en_HK
dc.languageengen_US
dc.publisherWiley-Blackwell Publishing, Inc.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=1045-3873en_HK
dc.relation.ispartofJournal of Cardiovascular Electrophysiologyen_HK
dc.rightsThe definitive version is available at www3.interscience.wiley.com-
dc.subjectatrial fibrillationen_HK
dc.subjectcatheter ablationen_HK
dc.subjectcomplex fractionated electrogramsen_HK
dc.subjectpulmonary veinsen_HK
dc.titleRandomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1045-3873&volume=22&issue=9&spage=973&epage=981&date=2011&atitle=Randomized+comparison+between+pulmonary+vein+antral+isolation+versus+complex+fractionated+electrogram+ablation+for+paroxysmal+atrial+fibrillation-
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1540-8167.2011.02051.xen_HK
dc.identifier.pmid21539635en_HK
dc.identifier.scopuseid_2-s2.0-80052837251en_HK
dc.identifier.hkuros187308en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-80052837251&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume22en_HK
dc.identifier.issue9en_HK
dc.identifier.spage973en_HK
dc.identifier.epage981en_HK
dc.identifier.isiWOS:000295131200004-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridChen, M=7406352614en_HK
dc.identifier.scopusauthoridYang, B=7404472488en_HK
dc.identifier.scopusauthoridChen, H=35298451700en_HK
dc.identifier.scopusauthoridJu, W=34771294900en_HK
dc.identifier.scopusauthoridZhang, F=36140901800en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridCao, K=7102713181en_HK

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