Linear ablation in addition to circumferential pulmonary vein isolation (Dallas lesion set) does not improve clinical outcome in patients with paroxysmal atrial fibrillation: a prospective randomized study.

Although the concept of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) was derived from maze surgery, it is unclear if linear ablation in addition to circumferential pulmonary vein isolation (CPVI) reduces the recurrence rate in patients with paroxysmal AF. Therefore, we compared clinical outcomes of CPVI with additional linear ablations (Dallas lesion set) and CPVI in a prospective randomized controlled study among patients with paroxysmal AF. This study enrolled 100 paroxysmal AF patients (male 75.0%, 56.4 ± 11.6 years old) who underwent RFCA and were randomly assigned to the CPVI group (n = 50) or the catheter Dallas lesion group (CPVI, posterior box lesion, and anterior linear ablation, n = 50). The catheter Dallas lesion group required longer procedure (190.3 ± 46.3 vs. 161.1 ± 30.3 min, P < 0.001) and ablation times (5345.4 ± 1676.4 vs. 4027.2 ± 878.0 s, P < 0.001) than the CPVI group. Complete bidirectional conduction block rate was 68.0% in the catheter Dallas lesion group and 100% in the CPVI group. Procedure-related complication rates were not significantly different between the catheter Dallas lesion (0%) and CPVI groups (4%, P = 0.157). During the 16.3 ± 4.0 months of follow-up, the clinical recurrence rates were not significantly different between the two groups (16.0% in the catheter Dallas lesion group vs. 12.0% in the CPVI group, P = 0.564), regardless of complete bidirectional conduction block achievement after linear ablation. Linear ablation in addition to CPVI (catheter Dallas lesion) did not improve clinical outcomes of RFCA in paroxysmal AF patients and required longer procedure times.

Kim TH ，Park J ，Park JK ，Uhm JS ，Joung B ，Hwang C ，Lee MH ，Pak HN ... -  《-》

Does Additional Electrogram-Guided Ablation After Linear Ablation Reduce Recurrence After Catheter Ablation for Longstanding Persistent Atrial Fibrillation? A Prospective Randomized Study.

Kim TH ，Uhm JS ，Kim JY ，Joung B ，Lee MH ，Pak HN ... -  《Journal of the American Heart Association》

Additional linear ablation from the superior vena cava to right atrial septum after pulmonary vein isolation improves the clinical outcome in patients with paroxysmal atrial fibrillation: prospective randomized study.

Although circumferential pulmonary vein isolation (CPVI) has been considered as the cornerstone for paroxysmal atrial fibrillation (PAF) ablation, there has been a substantial recurrence rate. We conducted a prospectively randomized study to evaluate whether additional linear ablation from the superior vena cava (SVC) to the right atrial (RA) septum (SVC-L) improves the clinical outcome. This study enroled 200 patients with PAF (male 74.5%, 56.8 ± 11.7 years old) randomly assigned to either the CPVI (n = 100) or CPVI + SVC-L (n = 100) groups. An RA isthmus ablation was performed in all patients. The CPVI + SVC-L group required a longer ablation procedure time (82.7 ± 17.9 min) than the CPVI group (63.6 ± 16.8 min, P < 0.001). The complication rates were 5% in CPVI + SVC-L group and 2% in CPVI group, respectively (P = 0.445). Two CPVI + SVC-L group patients had post-procedural sinus node dysfunction, which recovered within 24 h. During 12.2 ± 5.3 months of follow-up, the recurrence rate was significantly lower in the CPVI + SVC-L group (6%) than the CPVI group (27%, P < 0.001). The post-procedural 3-month follow-up heart rate variability in the CPVI + SVC-L group showed a significantly greater reduction in the rMSSD (25.2 ± 13.7 vs. 13.7 ± 8.5 ms, P < 0.001), HF (10.2 ± 7.1 vs. 5.5 ± 5.8 ms(2), P < 0.001), and LF/HF (1.6 ± 0.5 vs. 0.9 ± 0.3, P < 0.001) than in the CPVI group. In spite of a longer procedure time and risk of transient sinus node dysfunction, an SVC-L in addition to CPVI improved the clinical outcome of catheter ablation, and was associated with post-procedural autonomic neural remodelling in patients with PAF.

Kang KW ，Pak HN ，Park J ，Park JG ，Uhm JS ，Joung B ，Lee MH ，Hwang C ... -  《-》

Does additional linear ablation after circumferential pulmonary vein isolation improve clinical outcome in patients with paroxysmal atrial fibrillation? Prospective randomised study.

Mun HS ，Joung B ，Shim J ，Hwang HJ ，Kim JY ，Lee MH ，Pak HN ... -  《-》

Pulmonary Vein Isolation Alone Versus Additional Linear Ablation in Patients With Persistent Atrial Fibrillation Converted to Paroxysmal Type With Antiarrhythmic Drug Therapy: A Multicenter, Prospective, Randomized Study.

Atrial fibrillation (AF) type can vary depending on condition and timing, and some patients who initially present with persistent AF may be changed to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether circumferential pulmonary vein isolation (CPVI) alone is an effective rhythm control strategy in patients with persistent AF to paroxysmal AF. We enrolled 113 patients with persistent AF to paroxysmal AF (male 75%, 60.4±10.1 years old) who underwent catheter ablation for nonvalvular AF at 3 tertiary hospitals. The participants were randomly assigned to 2 groups: CPVI alone (n=59) or CPVI plus linear ablation (CPVI+Line; posterior box+anterior line, n=54). Compared with the CPVI+Line, CPVI alone required shorter procedure (187.2±58.0 versus 211.2±63.9 min; P=0.043) and ablation times (4922.1±1110.5 versus 6205.7±1425.2 s; P<0.001) without difference in procedure-related major complication (3% versus 2%; P=0.611). Antiarrhythmic drug utility rates after ablation were not different between the 2 groups (22% versus 30%; P=0.356). Overall, AF-free survival (log-rank; P=0.206) and AF and antiarrhythmic drug-free survival (log-rank; P=0.321) were not different between groups. CPVI alone is an effective rhythm control strategy with a shorter procedure time in persistent AF patients converted to paroxysmal AF compared with CPVI with linear ablation. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02176616.

Yu HT ，Shim J ，Park J ，Kim IS ，Kim TH ，Uhm JS ，Joung B ，Lee MH ，Kim YH ，Pak HN ... -  《-》