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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.

Authors
 Ki Woon Kang  ;  Hui Nam Pak  ;  Junbeom Park  ;  Jin Gyu Park  ;  Jae Sun Uhm  ;  Boyoung Joung  ;  Moon Hyoung Lee  ;  Chun Hwang 
Citation
 EUROPACE, Vol.16(12) : 1738-1745, 2014 
Journal Title
 EUROPACE 
ISSN
 1099-5129 
Issue Date
2014
MeSH
Atrial Fibrillation/diagnosis* ; Atrial Fibrillation/surgery* ; Atrial Septum/surgery* ; Body Surface Potential Mapping ; Catheter Ablation/methods* ; Female ; Heart Conduction System/surgery* ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Veins/surgery* ; Surgery, Computer-Assisted/methods ; Treatment Outcome ; Vena Cava, Superior/surgery*
Keywords
Catheter ablation ; Paroxysmal atrial fibrillation ; Recurrence ; Superior vena cava
Abstract
AIMS: 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. METHODS AND RESULTS: 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. CONCLUSION: 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.
Full Text
http://europace.oxfordjournals.org/content/16/12/1738
DOI
10.1093/europace/euu226
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Beom(박준범)
Park, Jin Kyu(박진규)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/138470
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