5-Year Outcome of Pulmonary Vein Isolation by Loss of Pace Capture on the Ablation Line Versus Electrical Circumferential Pulmonary Vein Isolation.

Moser, Julia; Sultan, Arian; Lüker, Jakob; Servatius, Helge; Salzbrunn, Tim; Altenburg, Manuel; Schäffer, Benjamin; Schreiber, Doreen; Akbulak, Ruken Ö; Vogler, Julia; Hoffmann, Boris A; Willems, Stephan; Steven, Daniel (2017). 5-Year Outcome of Pulmonary Vein Isolation by Loss of Pace Capture on the Ablation Line Versus Electrical Circumferential Pulmonary Vein Isolation. JACC Clinical electrophysiology, 3(11), pp. 1262-1271. Elsevier 10.1016/j.jacep.2017.04.019

[img] Text
1-s2.0-S2405500X17304218-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (664kB) | Request a copy

OBJECTIVES This study sought to compare long-term arrhythmia-free survival between electrical circumferential pulmonary vein isolation (PVI) and PVI with the endpoint of unexcitability along the ablation line. BACKGROUND PVI is the standard ablation strategy of paroxysmal atrial fibrillation, although arrhythmia recurrence in long-term follow-up (FU) is high. The endpoint of unexcitability along the ablation line results in decreased arrhythmia recurrence compared to electrical PVI in 1-year FU. METHODS Seventy-four consecutive patients (age 62.5 ± 10.6 years; 70.3% male) with de novo paroxysmal atrial fibrillation who were initially included in our randomized trial and underwent catheter ablation at our institution were analyzed. Patients who were randomized to either a conventional group (PVI, guided by circumferential catheter signals) or a pace-guided group (PG, anatomical ablation line encircling, ablation until loss of pace capture at 10 V, 2-ms pulse width on the ablation line) underwent long-term FU. The primary endpoint was recurrence of any atrial fibrillation or atrial tachycardia after a blanking period of 3 months. RESULTS Sixty-nine patients completed a mean FU period of 5.14 ± 0.98 years. Arrhythmia-free survival without antiarrhythmic drug therapy was significantly higher in the PG group (71.05% vs. 25.81%, p = 0.002). Furthermore, multiple procedure success (1.29 ± 0.61 procedures in PG vs. 1.97 ± 1.06 procedures in conventional group, p < 0.001) was higher in the PG group compared to the conventional group (89.47% vs. 58.06%, p = 0.005). CONCLUSIONS The endpoint of unexcitability along the PVI line improves success rates, resulting in a significant reduction of exposure to invasive procedures in 5-year FU.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Servatius, Helge Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2405-5018

Publisher:

Elsevier

Language:

English

Submitter:

PD Dr. Helge Simon Servatius

Date Deposited:

02 Oct 2019 14:15

Last Modified:

25 Oct 2019 11:39

Publisher DOI:

10.1016/j.jacep.2017.04.019

PubMed ID:

29759622

Uncontrolled Keywords:

atrial fibrillation catheter ablation loss of pace capture pulmonary vein isolation unexcitability

BORIS DOI:

10.7892/boris.127690

URI:

https://boris.unibe.ch/id/eprint/127690

Actions (login required)

Edit item Edit item
Provide Feedback