Author + information
- Received November 14, 2016
- Revision received April 12, 2017
- Accepted April 20, 2017
- Published online November 20, 2017.
- Julia Moser, MDa,∗ (, )
- Arian Sultan, MDb,
- Jakob Lüker, MDb,
- Helge Servatius, MDc,
- Tim Salzbrunna,
- Manuel Altenburga,
- Benjamin Schäffer, MDa,
- Doreen Schreiber, MDd,
- Ruken Ö. Akbulak, MDa,
- Julia Vogler, MDa,
- Boris A. Hoffmann, MDe,
- Stephan Willems, MDa and
- Daniel Steven, MDb
- aDepartment of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany
- bDepartment of Electrophysiology, University Heart Center Cologne, University Hospital Cologne, Cologne, Germany
- cDepartment of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- dDepartment of Electrophysiology, Clinic Hirslanden-Heart Center, Zurich, Switzerland
- eDepartment of Cardiology II/Electrophysiology, Center of Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- ↵∗Address for correspondence:
Dr. Julia Moser, Department of Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg, Germany.
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.
Dr. Schäffer has received lecture fees from St. Jude Medical and Boston Scientific. Dr. Willems has received a grant from St. Jude Medical; and lecture fees from St. Jude Medical, Biosense Webster, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received November 14, 2016.
- Revision received April 12, 2017.
- Accepted April 20, 2017.
- 2017 American College of Cardiology Foundation