Achievement of Pulmonary Vein Isolation in Patients Undergoing Circumferential Pulmonary Vein Ablation: A Randomized Comparison Between Two Different Isolation Approaches

Introduction: Circumferential pulmonary vein ablation (CPVA) with the endpoint of pulmonary vein (PV) isolation has been developed as an effective therapy for atrial fibrillation (AF). This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the c...

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Veröffentlicht in:Journal of cardiovascular electrophysiology 2006-12, Vol.17 (12), p.1263-1270
Hauptverfasser: LIU, XINGPENG, DONG, JIANZENG, MAVRAKIS, HERCULES E., HU, FULI, LONG, DEYONG, FANG, DONGPING, YU, RONGHUI, TANG, RIBO, HAO, PENG, LU, CHUNSHAN, HE, XIAOKUI, LIU, XIAOHUI, VARDAS, PANOS E., MA, CHANGSHENG
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container_end_page 1270
container_issue 12
container_start_page 1263
container_title Journal of cardiovascular electrophysiology
container_volume 17
creator LIU, XINGPENG
DONG, JIANZENG
MAVRAKIS, HERCULES E.
HU, FULI
LONG, DEYONG
FANG, DONGPING
YU, RONGHUI
TANG, RIBO
HAO, PENG
LU, CHUNSHAN
HE, XIAOKUI
LIU, XIAOHUI
VARDAS, PANOS E.
MA, CHANGSHENG
description Introduction: Circumferential pulmonary vein ablation (CPVA) with the endpoint of pulmonary vein (PV) isolation has been developed as an effective therapy for atrial fibrillation (AF). This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions. We investigated whether the clinical outcome depends on the PV isolation approach used during the first‐time CPVA procedure. Methods and Results: One hundred consecutive patients (69 male; age, 56.7 ± 11.6 years) who underwent first‐time CPVA for treatment of symptomatic AF were enrolled. PV isolation was randomly achieved either by CPVA alone (aggressive CPVA [A‐CPVA] group, n = 50) or by a combination of CPVA with segmental PV ostia ablation (modified CPVA [M‐CPVA] group, n = 50). Recurrence of atrial tachyarrhythmias (ATa) within 3 months after the initial procedure occurred in 30 patients (60%) in the M‐CPVA group and in only 15 patients (30%) in the A‐CPVA group (P < 0.01). ATa relapse after the first 3 months was detected in 21 patients (42%) in the M‐CPVA group, compared with 9 patients (18%) in the A‐CPVA group (P = 0.01). At 13 ± 4 months, patients treated by the A‐CPVA approach had greater freedom from ATa recurrence than patients who underwent M‐CPVA (P = 0.01). The M‐CPVA approach was the only independent predictor associated with procedural failure (RR 0.318; 95% CI 0.123–0.821; P = 0.02). Conclusions: When PV isolation is the endpoint of CPVA, the efficacy of the A‐CPVA approach is better than that of M‐CPVA.
doi_str_mv 10.1111/j.1540-8167.2006.00621.x
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This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions. We investigated whether the clinical outcome depends on the PV isolation approach used during the first‐time CPVA procedure. Methods and Results: One hundred consecutive patients (69 male; age, 56.7 ± 11.6 years) who underwent first‐time CPVA for treatment of symptomatic AF were enrolled. PV isolation was randomly achieved either by CPVA alone (aggressive CPVA [A‐CPVA] group, n = 50) or by a combination of CPVA with segmental PV ostia ablation (modified CPVA [M‐CPVA] group, n = 50). Recurrence of atrial tachyarrhythmias (ATa) within 3 months after the initial procedure occurred in 30 patients (60%) in the M‐CPVA group and in only 15 patients (30%) in the A‐CPVA group (P &lt; 0.01). ATa relapse after the first 3 months was detected in 21 patients (42%) in the M‐CPVA group, compared with 9 patients (18%) in the A‐CPVA group (P = 0.01). At 13 ± 4 months, patients treated by the A‐CPVA approach had greater freedom from ATa recurrence than patients who underwent M‐CPVA (P = 0.01). The M‐CPVA approach was the only independent predictor associated with procedural failure (RR 0.318; 95% CI 0.123–0.821; P = 0.02). 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This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions. We investigated whether the clinical outcome depends on the PV isolation approach used during the first‐time CPVA procedure. Methods and Results: One hundred consecutive patients (69 male; age, 56.7 ± 11.6 years) who underwent first‐time CPVA for treatment of symptomatic AF were enrolled. PV isolation was randomly achieved either by CPVA alone (aggressive CPVA [A‐CPVA] group, n = 50) or by a combination of CPVA with segmental PV ostia ablation (modified CPVA [M‐CPVA] group, n = 50). Recurrence of atrial tachyarrhythmias (ATa) within 3 months after the initial procedure occurred in 30 patients (60%) in the M‐CPVA group and in only 15 patients (30%) in the A‐CPVA group (P &lt; 0.01). ATa relapse after the first 3 months was detected in 21 patients (42%) in the M‐CPVA group, compared with 9 patients (18%) in the A‐CPVA group (P = 0.01). At 13 ± 4 months, patients treated by the A‐CPVA approach had greater freedom from ATa recurrence than patients who underwent M‐CPVA (P = 0.01). The M‐CPVA approach was the only independent predictor associated with procedural failure (RR 0.318; 95% CI 0.123–0.821; P = 0.02). 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This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions. We investigated whether the clinical outcome depends on the PV isolation approach used during the first‐time CPVA procedure. Methods and Results: One hundred consecutive patients (69 male; age, 56.7 ± 11.6 years) who underwent first‐time CPVA for treatment of symptomatic AF were enrolled. PV isolation was randomly achieved either by CPVA alone (aggressive CPVA [A‐CPVA] group, n = 50) or by a combination of CPVA with segmental PV ostia ablation (modified CPVA [M‐CPVA] group, n = 50). Recurrence of atrial tachyarrhythmias (ATa) within 3 months after the initial procedure occurred in 30 patients (60%) in the M‐CPVA group and in only 15 patients (30%) in the A‐CPVA group (P &lt; 0.01). ATa relapse after the first 3 months was detected in 21 patients (42%) in the M‐CPVA group, compared with 9 patients (18%) in the A‐CPVA group (P = 0.01). At 13 ± 4 months, patients treated by the A‐CPVA approach had greater freedom from ATa recurrence than patients who underwent M‐CPVA (P = 0.01). The M‐CPVA approach was the only independent predictor associated with procedural failure (RR 0.318; 95% CI 0.123–0.821; P = 0.02). Conclusions: When PV isolation is the endpoint of CPVA, the efficacy of the A‐CPVA approach is better than that of M‐CPVA.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>17239094</pmid><doi>10.1111/j.1540-8167.2006.00621.x</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Atrial Fibrillation - diagnosis
Atrial Fibrillation - prevention & control
Atrial Fibrillation - surgery
atrium
catheter ablation
Catheter Ablation - methods
Electrocardiography
Female
fibrillation
Heart Conduction System - surgery
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
pulmonary vein
Pulmonary Veins - surgery
Secondary Prevention
Treatment Outcome
title Achievement of Pulmonary Vein Isolation in Patients Undergoing Circumferential Pulmonary Vein Ablation: A Randomized Comparison Between Two Different Isolation Approaches
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