A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation
Objectives This study sought to determine whether ablation of complex fractionated atrial electrograms (CFAEs) after antral pulmonary vein isolation (APVI) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation (AF). Background Ablation of CFAEs ha...
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| creator | Oral, Hakan, MD Chugh, Aman, MD Yoshida, Kentaro, MD Sarrazin, Jean F., MD Kuhne, Michael, MD Crawford, Thomas, MD Chalfoun, Nagib, MD Wells, Darryl, MD Boonyapisit, Warangkna, MD Veerareddy, Srikar, MD Billakanty, Sreedhar, MD Wong, Wai S., MD Good, Eric, DO Jongnarangsin, Krit, MD Pelosi, Frank, MD Bogun, Frank, MD Morady, Fred, MD |
| description | Objectives This study sought to determine whether ablation of complex fractionated atrial electrograms (CFAEs) after antral pulmonary vein isolation (APVI) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation (AF). Background Ablation of CFAEs has been reported to eliminate persistent AF. However, residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence. Methods In this randomized study, 119 consecutive patients (mean age 60 ± 9 years) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter. Antral pulmonary vein isolation resulted in termination of AF in 19 of 119 patients (Group A, 16%). The remaining 100 patients who still were in AF were randomized to no further ablation and underwent cardioversion (Group B, n = 50) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration (Group C, n = 50). Results Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients (18%) in Group C. At 10 ± 3 months after a single ablation procedure, 18 of 50 (36%) in Group B and 17 of 50 (34%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.84). In Group A, 15 of 19 patients (79%) were in sinus rhythm. A repeat ablation procedure was performed in 34 of 100 randomized patients (for AF in 30 and atrial flutter in 4). At 9 ± 4 months after the final procedure, 34 of 50 (68%) in Group B and 30 of 50 (60%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.40). Conclusions Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF. |
| doi_str_mv | 10.1016/j.jacc.2008.10.054 |
| format | Article |
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Background Ablation of CFAEs has been reported to eliminate persistent AF. However, residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence. Methods In this randomized study, 119 consecutive patients (mean age 60 ± 9 years) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter. Antral pulmonary vein isolation resulted in termination of AF in 19 of 119 patients (Group A, 16%). The remaining 100 patients who still were in AF were randomized to no further ablation and underwent cardioversion (Group B, n = 50) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration (Group C, n = 50). Results Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients (18%) in Group C. At 10 ± 3 months after a single ablation procedure, 18 of 50 (36%) in Group B and 17 of 50 (34%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.84). In Group A, 15 of 19 patients (79%) were in sinus rhythm. A repeat ablation procedure was performed in 34 of 100 randomized patients (for AF in 30 and atrial flutter in 4). At 9 ± 4 months after the final procedure, 34 of 50 (68%) in Group B and 30 of 50 (60%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.40). Conclusions Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2008.10.054</identifier><identifier>PMID: 19245970</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Anticoagulants ; atrial fibrillation ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Catheter Ablation ; Catheters ; electrogram ; Electrophysiology ; Female ; Heart ; Heart Atria - physiopathology ; Humans ; Internal Medicine ; Male ; Medical sciences ; Middle Aged ; Molecular weight ; Pulmonary Veins - surgery ; Reoperation ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 2009-03, Vol.53 (9), p.782-789</ispartof><rights>American College of Cardiology Foundation</rights><rights>2009 American College of Cardiology Foundation</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited Mar 3, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c611t-e15c61028b983374d5f1b9014fd972e95c2689e76c48788e598d55e41c8947c73</citedby><cites>FETCH-LOGICAL-c611t-e15c61028b983374d5f1b9014fd972e95c2689e76c48788e598d55e41c8947c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2008.10.054$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>315,781,785,3551,27928,27929,45999</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21200870$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19245970$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oral, Hakan, MD</creatorcontrib><creatorcontrib>Chugh, Aman, MD</creatorcontrib><creatorcontrib>Yoshida, Kentaro, MD</creatorcontrib><creatorcontrib>Sarrazin, Jean F., MD</creatorcontrib><creatorcontrib>Kuhne, Michael, MD</creatorcontrib><creatorcontrib>Crawford, Thomas, MD</creatorcontrib><creatorcontrib>Chalfoun, Nagib, MD</creatorcontrib><creatorcontrib>Wells, Darryl, MD</creatorcontrib><creatorcontrib>Boonyapisit, Warangkna, MD</creatorcontrib><creatorcontrib>Veerareddy, Srikar, MD</creatorcontrib><creatorcontrib>Billakanty, Sreedhar, MD</creatorcontrib><creatorcontrib>Wong, Wai S., MD</creatorcontrib><creatorcontrib>Good, Eric, DO</creatorcontrib><creatorcontrib>Jongnarangsin, Krit, MD</creatorcontrib><creatorcontrib>Pelosi, Frank, MD</creatorcontrib><creatorcontrib>Bogun, Frank, MD</creatorcontrib><creatorcontrib>Morady, Fred, MD</creatorcontrib><title>A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives This study sought to determine whether ablation of complex fractionated atrial electrograms (CFAEs) after antral pulmonary vein isolation (APVI) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation (AF). Background Ablation of CFAEs has been reported to eliminate persistent AF. However, residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence. Methods In this randomized study, 119 consecutive patients (mean age 60 ± 9 years) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter. Antral pulmonary vein isolation resulted in termination of AF in 19 of 119 patients (Group A, 16%). The remaining 100 patients who still were in AF were randomized to no further ablation and underwent cardioversion (Group B, n = 50) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration (Group C, n = 50). Results Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients (18%) in Group C. At 10 ± 3 months after a single ablation procedure, 18 of 50 (36%) in Group B and 17 of 50 (34%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.84). In Group A, 15 of 19 patients (79%) were in sinus rhythm. A repeat ablation procedure was performed in 34 of 100 randomized patients (for AF in 30 and atrial flutter in 4). At 9 ± 4 months after the final procedure, 34 of 50 (68%) in Group B and 30 of 50 (60%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.40). Conclusions Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF.</description><subject>Anticoagulants</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Catheter Ablation</subject><subject>Catheters</subject><subject>electrogram</subject><subject>Electrophysiology</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Atria - physiopathology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Molecular weight</subject><subject>Pulmonary Veins - surgery</subject><subject>Reoperation</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kt-K1DAUxoso7uzqC3ghAXHvOiZt0yYgQhl2dGDAZf1zGzLp6ZixTWaTVFzfzXczcYoLe-FVwpff-XJyvmTZC4KXBJP6zWF5kEotC4xZFJaYVo-yBaGU5SXlzeNsgZuS5gTz5iw79_6AMa4Z4U-zM8KLKiJ4kf1u0Y00nR31L-hQ6z14P4IJyPYofAO0McpBEuSAbuwASW93gwzamrRf2fE4wE-0dlIlTYZkE5yO_NUAKji7d3L0qO0DONSa4OLJ9TSMkXV36Ctogzbezo69dWhrzT7fSh-02aNrcF77kDqaXdd65_Rw4p9lT3o5eHg-rxfZl_XV59WHfPvx_WbVbnNVExJyIDRucMF2nJVlU3W0JzuOSdV3vCmAU1XUjENTq4o1jAHlrKMUKqIYrxrVlBfZ5cn36OztBD6IUXsFsQsDdvKirqMPq1gEXz0AD3ZyJvYmCMV1UdWY40gVJ0o5672DXhydHuM4BMEiRSsOIkUrUrRJi9HGopez9bQbobsvmbOMwOsZkF7JoXfSKO3_cQVJbn-5tycO4sR-aHDCKw1GQaddDEx0Vv-_j3cPytWgjY43foc78PfvFb4QWHxKnzD9QcxwyUtclH8Aq8vYUQ</recordid><startdate>20090303</startdate><enddate>20090303</enddate><creator>Oral, Hakan, MD</creator><creator>Chugh, Aman, MD</creator><creator>Yoshida, Kentaro, MD</creator><creator>Sarrazin, Jean F., MD</creator><creator>Kuhne, Michael, MD</creator><creator>Crawford, Thomas, MD</creator><creator>Chalfoun, Nagib, MD</creator><creator>Wells, Darryl, MD</creator><creator>Boonyapisit, Warangkna, MD</creator><creator>Veerareddy, Srikar, MD</creator><creator>Billakanty, Sreedhar, MD</creator><creator>Wong, Wai S., MD</creator><creator>Good, Eric, DO</creator><creator>Jongnarangsin, Krit, MD</creator><creator>Pelosi, Frank, MD</creator><creator>Bogun, Frank, MD</creator><creator>Morady, Fred, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><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>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20090303</creationdate><title>A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation</title><author>Oral, Hakan, MD ; Chugh, Aman, MD ; Yoshida, Kentaro, MD ; Sarrazin, Jean F., MD ; Kuhne, Michael, MD ; Crawford, Thomas, MD ; Chalfoun, Nagib, MD ; Wells, Darryl, MD ; Boonyapisit, Warangkna, MD ; Veerareddy, Srikar, MD ; Billakanty, Sreedhar, MD ; Wong, Wai S., MD ; Good, Eric, DO ; Jongnarangsin, Krit, MD ; Pelosi, Frank, MD ; Bogun, Frank, MD ; Morady, Fred, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c611t-e15c61028b983374d5f1b9014fd972e95c2689e76c48788e598d55e41c8947c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Anticoagulants</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Catheter Ablation</topic><topic>Catheters</topic><topic>electrogram</topic><topic>Electrophysiology</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Atria - physiopathology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Molecular weight</topic><topic>Pulmonary Veins - surgery</topic><topic>Reoperation</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oral, Hakan, MD</creatorcontrib><creatorcontrib>Chugh, Aman, MD</creatorcontrib><creatorcontrib>Yoshida, Kentaro, MD</creatorcontrib><creatorcontrib>Sarrazin, Jean F., MD</creatorcontrib><creatorcontrib>Kuhne, Michael, MD</creatorcontrib><creatorcontrib>Crawford, Thomas, MD</creatorcontrib><creatorcontrib>Chalfoun, Nagib, MD</creatorcontrib><creatorcontrib>Wells, Darryl, MD</creatorcontrib><creatorcontrib>Boonyapisit, Warangkna, MD</creatorcontrib><creatorcontrib>Veerareddy, Srikar, MD</creatorcontrib><creatorcontrib>Billakanty, Sreedhar, MD</creatorcontrib><creatorcontrib>Wong, Wai S., MD</creatorcontrib><creatorcontrib>Good, Eric, DO</creatorcontrib><creatorcontrib>Jongnarangsin, Krit, MD</creatorcontrib><creatorcontrib>Pelosi, Frank, MD</creatorcontrib><creatorcontrib>Bogun, Frank, MD</creatorcontrib><creatorcontrib>Morady, Fred, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oral, Hakan, MD</au><au>Chugh, Aman, MD</au><au>Yoshida, Kentaro, MD</au><au>Sarrazin, Jean F., MD</au><au>Kuhne, Michael, MD</au><au>Crawford, Thomas, MD</au><au>Chalfoun, Nagib, MD</au><au>Wells, Darryl, MD</au><au>Boonyapisit, Warangkna, MD</au><au>Veerareddy, Srikar, MD</au><au>Billakanty, Sreedhar, MD</au><au>Wong, Wai S., MD</au><au>Good, Eric, DO</au><au>Jongnarangsin, Krit, MD</au><au>Pelosi, Frank, MD</au><au>Bogun, Frank, MD</au><au>Morady, Fred, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2009-03-03</date><risdate>2009</risdate><volume>53</volume><issue>9</issue><spage>782</spage><epage>789</epage><pages>782-789</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Objectives This study sought to determine whether ablation of complex fractionated atrial electrograms (CFAEs) after antral pulmonary vein isolation (APVI) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation (AF). Background Ablation of CFAEs has been reported to eliminate persistent AF. However, residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence. Methods In this randomized study, 119 consecutive patients (mean age 60 ± 9 years) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter. Antral pulmonary vein isolation resulted in termination of AF in 19 of 119 patients (Group A, 16%). The remaining 100 patients who still were in AF were randomized to no further ablation and underwent cardioversion (Group B, n = 50) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration (Group C, n = 50). Results Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients (18%) in Group C. At 10 ± 3 months after a single ablation procedure, 18 of 50 (36%) in Group B and 17 of 50 (34%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.84). In Group A, 15 of 19 patients (79%) were in sinus rhythm. A repeat ablation procedure was performed in 34 of 100 randomized patients (for AF in 30 and atrial flutter in 4). At 9 ± 4 months after the final procedure, 34 of 50 (68%) in Group B and 30 of 50 (60%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.40). Conclusions Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>19245970</pmid><doi>10.1016/j.jacc.2008.10.054</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anticoagulants atrial fibrillation Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Biological and medical sciences Cardiac arrhythmia Cardiac dysrhythmias Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Catheter Ablation Catheters electrogram Electrophysiology Female Heart Heart Atria - physiopathology Humans Internal Medicine Male Medical sciences Middle Aged Molecular weight Pulmonary Veins - surgery Reoperation Time Factors Treatment Outcome |
| title | A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation |
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