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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Ablation for longstanding permanent atrial fibrillation: Results from a randomized study comparing three different strategies
Heart Rhythm, Volume 5, No. 12, Year 2008
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Description
Background: This prospective multicenter randomized study aimed to compare the efficacy of 3 common ablation methods used for longstanding permanent atrial fibrillation (AF). Methods: A total of 144 patients with longstanding permanent AF (median duration 28 months) were randomly assigned to circumferential pulmonary vein ablation (CPVA, group 1, n = 47), to pulmonary vein antrum isolation (PVAI, group 2, n = 48) or to a hybrid strategy combining ablation of complex fractionated or rapid atrial electrograms (CFAE) in both atria followed by a pulmonary vein antrum isolation (CFAE + PVAI, group 3, n = 49). Results: Scarring in the left atrium and structural heart disease/hypertension were present in most patients (65%). After a mean follow-up of 16 months, 11% of patients in group 1, 40% of patients in group 2 and 61% of patients in group 3 were in sinus rhythm after one procedure and with no antiarrhythmic drugs (P < .001). Sinus rhythm maintenance would increase respectively to 28% (group 1), 83% (group 2), and 94% (group 3) after 2 procedures and with antiarrhythmic drugs (AADs, P < .001). The AF terminated during ablation, either by conversion to sinus rhythm or organization into an atrial tachyarrhythmia, in 13% of patients (group 1), 44% (group 2), and 74% (group 3) respectively. CFAE alone, performed as the first step of the ablation in group 3, organized AF in only 1 patient. Conclusion: In this study, the hybrid AF ablation strategy including antrum isolation and CFAE ablation had the highest likelihood of maintaining sinus rhythm in patients with longstanding permanent AF. Electrical isolation of the PVs, although inadequate if performed alone, is relevant to achieve long-term sinus rhythm maintenance after ablation. Bi-atrial CFAE ablation had a minimal impact on AF termination during ablation. © 2008 Heart Rhythm Society.
Authors & Co-Authors
Elayi, Claude Samy
France, Boulogne-billancourt
Hopital Ambroise Pare, Boulogne-billancourt
Italy, Mestre
Ospedale Umberto i, Mestre
Verma, Atul
Canada, Newmarket
Southlake Regional Health Centre
Italy, Mestre
Ospedale Umberto i, Mestre
Di Biase, Luigi
Italy, Foggia
Università Degli Studi Di Foggia
United States, Austin
St. David's Medical Center
Italy, Mestre
Ospedale Umberto i, Mestre
Ching, Chi Keong
Italy, Mestre
Ospedale Umberto i, Mestre
Singapore, Singapore City
National Heart Centre Singapore
Patel, Dimpi
United States, Austin
St. David's Medical Center
Italy, Mestre
Ospedale Umberto i, Mestre
Barrett, Conor
Italy, Mestre
Ospedale Umberto i, Mestre
United States, Boston
Massachusetts General Hospital
Martin, David
United States, Cleveland
Cleveland Clinic Foundation
Italy, Mestre
Ospedale Umberto i, Mestre
Rong, Bai
Italy, Mestre
Ospedale Umberto i, Mestre
China, Wuhan
Tongji Hospital
Fahmy, Tamer S.
Italy, Mestre
Ospedale Umberto i, Mestre
Egypt, Cairo
Faculty of Medicine
Khaykin, Yaariv
Canada, Newmarket
Southlake Regional Health Centre
Italy, Mestre
Ospedale Umberto i, Mestre
Hongo, Richard
United States, San Francisco
Sutter Pacific Heart Centers
Italy, Mestre
Ospedale Umberto i, Mestre
Hao, Steven
United States, San Francisco
Sutter Pacific Heart Centers
Italy, Mestre
Ospedale Umberto i, Mestre
Pelargonio, Gemma
Italy, Rome
Università Cattolica Del Sacro Cuore, Campus Di Roma
Italy, Mestre
Ospedale Umberto i, Mestre
Dello Russo, Antonio
Italy, Rome
Università Cattolica Del Sacro Cuore, Campus Di Roma
Italy, Mestre
Ospedale Umberto i, Mestre
Casella, Michela
Italy, Rome
Università Cattolica Del Sacro Cuore, Campus Di Roma
Italy, Mestre
Ospedale Umberto i, Mestre
Santarelli, Pietro
Italy, Rome
Università Cattolica Del Sacro Cuore, Campus Di Roma
Italy, Mestre
Ospedale Umberto i, Mestre
Potenza, Domenico Rosario
Italy, Mestre
Ospedale Umberto i, Mestre
Italy, San Giovanni Rotondo
Irccs Casa Sollievo Della Sofferenza
Fanelli, Raffaele
Italy, Mestre
Ospedale Umberto i, Mestre
Italy, San Giovanni Rotondo
Irccs Casa Sollievo Della Sofferenza
Massaro, Raimondo
Italy, Mestre
Ospedale Umberto i, Mestre
Italy, San Giovanni Rotondo
Irccs Casa Sollievo Della Sofferenza
Arruda, Mauricio
Italy, Mestre
Ospedale Umberto i, Mestre
United States, Cleveland
Case School of Medicine
Schweikert, Robert A.
Italy, Mestre
Ospedale Umberto i, Mestre
United States, Akron
Akron General Hospital
Natale, Andrea
France, Boulogne-billancourt
Hopital Ambroise Pare, Boulogne-billancourt
Italy, Mestre
Ospedale Umberto i, Mestre
United States, Palo Alto
Stanford University
United States, Cleveland
Case School of Medicine
Statistics
Citations: 307
Authors: 22
Affiliations: 16
Identifiers
Doi:
10.1016/j.hrthm.2008.09.016
ISSN:
15475271
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study