Author + information
- V. Shabanov,
- J.S. Steinberg,
- A. Romanov,
- S. Bayramova,
- D. Losik,
- D. Ponomarev,
- I. Stenin,
- D. Elesin,
- I. Mikheenko and
- E. Pokushalov
The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with typical atrial flutter (AFL) resulted in substantial reduction of new onset atrial fibrillation (AF) during 1-year follow up as assessed by continuous implantable loop recorder (ILR).
To assess the 3-year outcome in AF prevention by prophylactic PVI in patients with only typical AFL.
Fifty patients with documented AFL were randomized to either cavo-tricuspid isthmus (CTI) ablation alone (n=25) or CTI with concomitant PVI (PVI; n=25). All patients received an ILR with regular follow-up for 3 years following initial ablation. The primary endpoint of the study was the occurrence of any atrial tachyarrhythmia including AF or AFL after ablation with the monthly burden exceeding 0.5% on the ILR.
At the end of 3 years, 80% of the patients in CTI only group vs 52% of the patients in PVI+CTI group developed AF/AFl recurrences [hazard ratio (HR) 2.40, 95% confidence interval (CI) 1.18–4.86, P = 0.015] (see Figure). More patients in the CTI only group underwent redo ablation compared to PVI+CTI group, 32% vs 8%, respectively (p = 0.037). The three-year AF burden also favored the combined ablation group compared to the CTI ablation only group: 6.2% vs 16.8% (p = 0.038). In CTI only group, 12 (48%) patients were hospitalized during follow-up compared to 4 (16%) in PVI+CTI group (p=0.032). Two patients in CTI only group developed stroke with no clinical adverse events in PVI+CTI group.
Prophylactic PVI in patients with only typical AFL resulted in a significant reduction of new onset AF and burden during long-term follow-up as assessed by continuous ILR, with consequent reduction in hospitalizations and need to perform repeat ablation for AF.
Clinical Trials Registration: NCT01563848