• Europace · Sep 2015

    Randomized Controlled Trial Comparative Study

    Recurrence of paroxysmal atrial fibrillation after pulmonary vein isolation: is repeat pulmonary vein isolation enough? A prospective, randomized trial.

    • Stephanie Fichtner, Korbinian Sparn, Tilko Reents, Sonia Ammar, Verena Semmler, Roger Dillier, Alexandra Buiatti, Susanne Kathan, Gabriele Hessling, and Isabel Deisenhofer.
    • Medizinische Klinik I, Klinikum der Universität München, Marchioninistr. 15, Munich 81377, Germany sf@sfichtner.de.
    • Europace. 2015 Sep 1; 17 (9): 1371-5.

    AimsIn patients with paroxysmal atrial fibrillation (pAF), pulmonary vein isolation (PVI) has become an accepted treatment option with single procedure success rates of 60-80%. A repeat ablation is performed in ∼30% of patients because of arrhythmia recurrence. The strategy for this repeat procedure is not defined.Methods And ResultsPatients with pAF recurrence after PVI were prospectively randomized and underwent a second ablation procedure with either PVI of all reconnected veins or PVI with an additional left atrial anterior line. Follow-up in our arrhythmia clinic was every 3 months up to 12 months including 7 day Holter monitoring. A total of 77 patients (mean age 63 ± 9 years, 69% males) were included in the analysis. A repeat PVI was performed in 41 patients, PVI + anterior line in 36 patients. After a follow-up of 12 months, 26 of 41 (63%) patients after repeat PVI and 18 of 36 (50%) patients with PVI + anterior line were in stable sinus rhythm off antiarrhythmic medication (P = 0.26). In most patients (12 of 15 patients with PVI and 14 of 18 patients with PVI + anterior line) with an arrhythmia recurrence after the second procedure, the recurring arrhythmia was paroxysmal AF. In 2 of 15 patients of the PVI group and in 4 of 18 patients of the PVI + anterior line group atypical flutter was the reoccurring arrhythmia (P = NS).ConclusionIn this prospective randomized trial, patients with a recurrence of paroxysmal AF had no better outcome after repeat PVI + one left atrial line compared with patients with repeat PVI only.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

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