Efficacy of Extensive Ablation for Persistent Atrial Fibrillation With Trigger-Based vs. Substrate-Based Mechanisms ― A Prespecified Subanalysis of the EARNEST-PVI Trial
Background:Extensive ablation in addition to pulmonary vein isolation (PVI) would be effective for modification of non-pulmonary vein (non-PV) substrates, whereas PVI might be sufficient for elimination of PV triggers. This study aimed to test the hypothesis that in patients with reproducible atrial...
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| Veröffentlicht in: | Circulation Journal 2021/09/24, Vol.85(10), pp.1897-1905 |
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| container_end_page | 1905 |
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| container_title | Circulation Journal |
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| creator | Inoue, Koichi Sotomi, Yohei Masuda, Masaharu Furukawa, Yoshio Hirata, Akio Egami, Yasuyuki Watanabe, Tetsuya Minamiguchi, Hitoshi Miyoshi, Miwa Tanaka, Nobuaki Oka, Takafumi Okada, Masato Kanda, Takashi Matsuda, Yasuhiro Kawasaki, Masato Kitamura, Tetsuhisa Dohi, Tomoharu Sunaga, Akihiro Mizuno, Hiroya Nakatani, Daisaku Hikoso, Shungo Sakata, Yasushi on behalf of the OCVC Arrhythmia Investigators |
| description | Background:Extensive ablation in addition to pulmonary vein isolation (PVI) would be effective for modification of non-pulmonary vein (non-PV) substrates, whereas PVI might be sufficient for elimination of PV triggers. This study aimed to test the hypothesis that in patients with reproducible atrial fibrillation (AF) triggered by premature atrial contractions originating only from PVs, PVI alone can be sufficient to maintain sinus rhythm.Methods and Results:This study is a prespecified subanalysis of the EARNEST-PVI randomized controlled trial. This study investigated the efficacy of the PVI-alone strategy (PVI-alone) in comparison with the extensive strategy (PVI-plus) for persistent AF with a trigger-based mechanism vs. a substrate-based mechanism. Patients were stratified into 3 groups based on AF mechanisms: (1) Substrate group (N=236); (2) PV trigger group (N=236); and (3) non-PV trigger group (N=24). The hazard ratios for AF recurrence of the PVI-alone strategy with reference to the PVI-plus strategy were 1.456 (95% confidence interval [CI] [0.864–2.452]) in the substrate group, 1.648 (95% CI 0.969–2.801) in the PV trigger group, and 0.937 (95% CI 0.252–3.488) in the non-PV trigger group. No significant interaction between ablation strategy and AF mechanism was observed (P for interaction=0.748).Conclusions:This study indicated that the efficacies of the PVI-alone strategy compared with the PVI-plus strategy were consistent across persistent AF with trigger-based and substrate-based mechanisms. |
| doi_str_mv | 10.1253/circj.CJ-21-0126 |
| format | Article |
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This study aimed to test the hypothesis that in patients with reproducible atrial fibrillation (AF) triggered by premature atrial contractions originating only from PVs, PVI alone can be sufficient to maintain sinus rhythm.Methods and Results:This study is a prespecified subanalysis of the EARNEST-PVI randomized controlled trial. This study investigated the efficacy of the PVI-alone strategy (PVI-alone) in comparison with the extensive strategy (PVI-plus) for persistent AF with a trigger-based mechanism vs. a substrate-based mechanism. Patients were stratified into 3 groups based on AF mechanisms: (1) Substrate group (N=236); (2) PV trigger group (N=236); and (3) non-PV trigger group (N=24). The hazard ratios for AF recurrence of the PVI-alone strategy with reference to the PVI-plus strategy were 1.456 (95% confidence interval [CI] [0.864–2.452]) in the substrate group, 1.648 (95% CI 0.969–2.801) in the PV trigger group, and 0.937 (95% CI 0.252–3.488) in the non-PV trigger group. No significant interaction between ablation strategy and AF mechanism was observed (P for interaction=0.748).Conclusions:This study indicated that the efficacies of the PVI-alone strategy compared with the PVI-plus strategy were consistent across persistent AF with trigger-based and substrate-based mechanisms.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-21-0126</identifier><identifier>PMID: 33775981</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Atrial Fibrillation - surgery ; Catheter Ablation - methods ; Humans ; Persistent atrial fibrillation ; Pulmonary vein isolation ; Pulmonary Veins - surgery ; Randomized controlled trial ; Recurrence ; Substrate ; Treatment Outcome ; Trigger</subject><ispartof>Circulation Journal, 2021/09/24, Vol.85(10), pp.1897-1905</ispartof><rights>2021, THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-5a79f6fe07ef49b11ce1ee60113ede8732b1c8e8fdd2ffa4c182fe2678fb8e463</citedby><cites>FETCH-LOGICAL-c495t-5a79f6fe07ef49b11ce1ee60113ede8732b1c8e8fdd2ffa4c182fe2678fb8e463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1876,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33775981$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Inoue, Koichi</creatorcontrib><creatorcontrib>Sotomi, Yohei</creatorcontrib><creatorcontrib>Masuda, Masaharu</creatorcontrib><creatorcontrib>Furukawa, Yoshio</creatorcontrib><creatorcontrib>Hirata, Akio</creatorcontrib><creatorcontrib>Egami, Yasuyuki</creatorcontrib><creatorcontrib>Watanabe, Tetsuya</creatorcontrib><creatorcontrib>Minamiguchi, Hitoshi</creatorcontrib><creatorcontrib>Miyoshi, Miwa</creatorcontrib><creatorcontrib>Tanaka, Nobuaki</creatorcontrib><creatorcontrib>Oka, Takafumi</creatorcontrib><creatorcontrib>Okada, Masato</creatorcontrib><creatorcontrib>Kanda, Takashi</creatorcontrib><creatorcontrib>Matsuda, Yasuhiro</creatorcontrib><creatorcontrib>Kawasaki, Masato</creatorcontrib><creatorcontrib>Kitamura, Tetsuhisa</creatorcontrib><creatorcontrib>Dohi, Tomoharu</creatorcontrib><creatorcontrib>Sunaga, Akihiro</creatorcontrib><creatorcontrib>Mizuno, Hiroya</creatorcontrib><creatorcontrib>Nakatani, Daisaku</creatorcontrib><creatorcontrib>Hikoso, Shungo</creatorcontrib><creatorcontrib>Sakata, Yasushi</creatorcontrib><creatorcontrib>on behalf of the OCVC Arrhythmia Investigators</creatorcontrib><creatorcontrib>OCVC Arrhythmia Investigators</creatorcontrib><creatorcontrib>on behalf of the OCVC Arrhythmia Investigators</creatorcontrib><title>Efficacy of Extensive Ablation for Persistent Atrial Fibrillation With Trigger-Based vs. Substrate-Based Mechanisms ― A Prespecified Subanalysis of the EARNEST-PVI Trial</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background:Extensive ablation in addition to pulmonary vein isolation (PVI) would be effective for modification of non-pulmonary vein (non-PV) substrates, whereas PVI might be sufficient for elimination of PV triggers. This study aimed to test the hypothesis that in patients with reproducible atrial fibrillation (AF) triggered by premature atrial contractions originating only from PVs, PVI alone can be sufficient to maintain sinus rhythm.Methods and Results:This study is a prespecified subanalysis of the EARNEST-PVI randomized controlled trial. This study investigated the efficacy of the PVI-alone strategy (PVI-alone) in comparison with the extensive strategy (PVI-plus) for persistent AF with a trigger-based mechanism vs. a substrate-based mechanism. Patients were stratified into 3 groups based on AF mechanisms: (1) Substrate group (N=236); (2) PV trigger group (N=236); and (3) non-PV trigger group (N=24). The hazard ratios for AF recurrence of the PVI-alone strategy with reference to the PVI-plus strategy were 1.456 (95% confidence interval [CI] [0.864–2.452]) in the substrate group, 1.648 (95% CI 0.969–2.801) in the PV trigger group, and 0.937 (95% CI 0.252–3.488) in the non-PV trigger group. No significant interaction between ablation strategy and AF mechanism was observed (P for interaction=0.748).Conclusions:This study indicated that the efficacies of the PVI-alone strategy compared with the PVI-plus strategy were consistent across persistent AF with trigger-based and substrate-based mechanisms.</description><subject>Atrial Fibrillation - surgery</subject><subject>Catheter Ablation - methods</subject><subject>Humans</subject><subject>Persistent atrial fibrillation</subject><subject>Pulmonary vein isolation</subject><subject>Pulmonary Veins - surgery</subject><subject>Randomized controlled trial</subject><subject>Recurrence</subject><subject>Substrate</subject><subject>Treatment Outcome</subject><subject>Trigger</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkc1u1DAUhSMEoqWwZ4W8ZOOpf_LjLMMoLa0KjOgAS8txrmc8yiSD7amY3bxEH6Mv1b5Ik05oJcu-8v3uObZOFH2kZEJZwk-1dXo1mV5iRjGhLH0VHVMeZzgWjLx-qlOci5gfRe-8XxHCcpLkb6MjzrMsyQU9ju5KY6xWeoc6g8p_AVpvbwAVVaOC7VpkOodm4Lz1fSugIjirGnRmK2ebEfljwxLNnV0swOEvykONbvwEXW8rH5wKMN59A71UrfVr_7Df3-9vUYFmDvwGtDW27_e8alWz662Gt4QloLL4-b28nuPZ74vBQDXvozdGNR4-jOdJ9OusnE-_4qsf5xfT4grrOE8CTlSWm9QAycDEeUWpBgqQEko51CAyziqqBQhT18wYFWsqmAGWZsJUAuKUn0SfD7ob1_3dgg9ybb2G_sctdFsvWULSfgk2oOSAatd578DIjbNr5XaSEjmEJJ9CktNLyagcQupHPo3q22oN9fPA_1R64PwArHxQC3gGlAtWNzAqimSw6PcX6RdiqZyElj8CuY2sfA</recordid><startdate>20210924</startdate><enddate>20210924</enddate><creator>Inoue, Koichi</creator><creator>Sotomi, Yohei</creator><creator>Masuda, Masaharu</creator><creator>Furukawa, Yoshio</creator><creator>Hirata, Akio</creator><creator>Egami, Yasuyuki</creator><creator>Watanabe, Tetsuya</creator><creator>Minamiguchi, Hitoshi</creator><creator>Miyoshi, Miwa</creator><creator>Tanaka, Nobuaki</creator><creator>Oka, Takafumi</creator><creator>Okada, Masato</creator><creator>Kanda, Takashi</creator><creator>Matsuda, Yasuhiro</creator><creator>Kawasaki, Masato</creator><creator>Kitamura, Tetsuhisa</creator><creator>Dohi, Tomoharu</creator><creator>Sunaga, Akihiro</creator><creator>Mizuno, Hiroya</creator><creator>Nakatani, Daisaku</creator><creator>Hikoso, Shungo</creator><creator>Sakata, Yasushi</creator><creator>on behalf of the OCVC Arrhythmia Investigators</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210924</creationdate><title>Efficacy of Extensive Ablation for Persistent Atrial Fibrillation With Trigger-Based vs. Substrate-Based Mechanisms ― A Prespecified Subanalysis of the EARNEST-PVI Trial</title><author>Inoue, Koichi ; Sotomi, Yohei ; Masuda, Masaharu ; Furukawa, Yoshio ; Hirata, Akio ; Egami, Yasuyuki ; Watanabe, Tetsuya ; Minamiguchi, Hitoshi ; Miyoshi, Miwa ; Tanaka, Nobuaki ; Oka, Takafumi ; Okada, Masato ; Kanda, Takashi ; Matsuda, Yasuhiro ; Kawasaki, Masato ; Kitamura, Tetsuhisa ; Dohi, Tomoharu ; Sunaga, Akihiro ; Mizuno, Hiroya ; Nakatani, Daisaku ; Hikoso, Shungo ; Sakata, Yasushi ; on behalf of the OCVC Arrhythmia Investigators</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-5a79f6fe07ef49b11ce1ee60113ede8732b1c8e8fdd2ffa4c182fe2678fb8e463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Atrial Fibrillation - surgery</topic><topic>Catheter Ablation - methods</topic><topic>Humans</topic><topic>Persistent atrial fibrillation</topic><topic>Pulmonary vein isolation</topic><topic>Pulmonary Veins - surgery</topic><topic>Randomized controlled trial</topic><topic>Recurrence</topic><topic>Substrate</topic><topic>Treatment Outcome</topic><topic>Trigger</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Inoue, Koichi</creatorcontrib><creatorcontrib>Sotomi, Yohei</creatorcontrib><creatorcontrib>Masuda, Masaharu</creatorcontrib><creatorcontrib>Furukawa, Yoshio</creatorcontrib><creatorcontrib>Hirata, Akio</creatorcontrib><creatorcontrib>Egami, Yasuyuki</creatorcontrib><creatorcontrib>Watanabe, Tetsuya</creatorcontrib><creatorcontrib>Minamiguchi, Hitoshi</creatorcontrib><creatorcontrib>Miyoshi, Miwa</creatorcontrib><creatorcontrib>Tanaka, Nobuaki</creatorcontrib><creatorcontrib>Oka, Takafumi</creatorcontrib><creatorcontrib>Okada, Masato</creatorcontrib><creatorcontrib>Kanda, Takashi</creatorcontrib><creatorcontrib>Matsuda, Yasuhiro</creatorcontrib><creatorcontrib>Kawasaki, Masato</creatorcontrib><creatorcontrib>Kitamura, Tetsuhisa</creatorcontrib><creatorcontrib>Dohi, Tomoharu</creatorcontrib><creatorcontrib>Sunaga, Akihiro</creatorcontrib><creatorcontrib>Mizuno, Hiroya</creatorcontrib><creatorcontrib>Nakatani, Daisaku</creatorcontrib><creatorcontrib>Hikoso, Shungo</creatorcontrib><creatorcontrib>Sakata, Yasushi</creatorcontrib><creatorcontrib>on behalf of the OCVC Arrhythmia Investigators</creatorcontrib><creatorcontrib>OCVC Arrhythmia Investigators</creatorcontrib><creatorcontrib>on behalf of the OCVC Arrhythmia Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Inoue, Koichi</au><au>Sotomi, Yohei</au><au>Masuda, Masaharu</au><au>Furukawa, Yoshio</au><au>Hirata, Akio</au><au>Egami, Yasuyuki</au><au>Watanabe, Tetsuya</au><au>Minamiguchi, Hitoshi</au><au>Miyoshi, Miwa</au><au>Tanaka, Nobuaki</au><au>Oka, Takafumi</au><au>Okada, Masato</au><au>Kanda, Takashi</au><au>Matsuda, Yasuhiro</au><au>Kawasaki, Masato</au><au>Kitamura, Tetsuhisa</au><au>Dohi, Tomoharu</au><au>Sunaga, Akihiro</au><au>Mizuno, Hiroya</au><au>Nakatani, Daisaku</au><au>Hikoso, Shungo</au><au>Sakata, Yasushi</au><au>on behalf of the OCVC Arrhythmia Investigators</au><aucorp>OCVC Arrhythmia Investigators</aucorp><aucorp>on behalf of the OCVC Arrhythmia Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of Extensive Ablation for Persistent Atrial Fibrillation With Trigger-Based vs. Substrate-Based Mechanisms ― A Prespecified Subanalysis of the EARNEST-PVI Trial</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2021-09-24</date><risdate>2021</risdate><volume>85</volume><issue>10</issue><spage>1897</spage><epage>1905</epage><pages>1897-1905</pages><artnum>CJ-21-0126</artnum><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>Background:Extensive ablation in addition to pulmonary vein isolation (PVI) would be effective for modification of non-pulmonary vein (non-PV) substrates, whereas PVI might be sufficient for elimination of PV triggers. This study aimed to test the hypothesis that in patients with reproducible atrial fibrillation (AF) triggered by premature atrial contractions originating only from PVs, PVI alone can be sufficient to maintain sinus rhythm.Methods and Results:This study is a prespecified subanalysis of the EARNEST-PVI randomized controlled trial. This study investigated the efficacy of the PVI-alone strategy (PVI-alone) in comparison with the extensive strategy (PVI-plus) for persistent AF with a trigger-based mechanism vs. a substrate-based mechanism. Patients were stratified into 3 groups based on AF mechanisms: (1) Substrate group (N=236); (2) PV trigger group (N=236); and (3) non-PV trigger group (N=24). The hazard ratios for AF recurrence of the PVI-alone strategy with reference to the PVI-plus strategy were 1.456 (95% confidence interval [CI] [0.864–2.452]) in the substrate group, 1.648 (95% CI 0.969–2.801) in the PV trigger group, and 0.937 (95% CI 0.252–3.488) in the non-PV trigger group. No significant interaction between ablation strategy and AF mechanism was observed (P for interaction=0.748).Conclusions:This study indicated that the efficacies of the PVI-alone strategy compared with the PVI-plus strategy were consistent across persistent AF with trigger-based and substrate-based mechanisms.</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>33775981</pmid><doi>10.1253/circj.CJ-21-0126</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | J-STAGE Free; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Atrial Fibrillation - surgery Catheter Ablation - methods Humans Persistent atrial fibrillation Pulmonary vein isolation Pulmonary Veins - surgery Randomized controlled trial Recurrence Substrate Treatment Outcome Trigger |
| title | Efficacy of Extensive Ablation for Persistent Atrial Fibrillation With Trigger-Based vs. Substrate-Based Mechanisms ― A Prespecified Subanalysis of the EARNEST-PVI Trial |
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