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Pulmonary Vein Isolation Alone Versus Additional Linear Ablation in Patients With Persistent Atrial Fibrillation Converted to Paroxysmal Type With Antiarrhythmic Drug Therapy: A Multicenter, Prospective, Randomized Study

Authors
 Hee Tae Yu  ;  Jaemin Shim  ;  Junbeom Park  ;  In-Soo Kim  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Young-Hoon Kim  ;  Hui-Nam Pak 
Citation
 CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol.10(6) : e004915, 2017 
Journal Title
 CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY 
ISSN
 1941-3149 
Issue Date
2017
MeSH
Action Potentials ; Aged ; Anti-Arrhythmia Agents/adverse effects ; Anti-Arrhythmia Agents/therapeutic use* ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery* ; Catheter Ablation/adverse effects ; Catheter Ablation/methods* ; Disease-Free Survival ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Operative Time ; Prospective Studies ; Pulmonary Veins/physiopathology ; Pulmonary Veins/surgery* ; Seoul Tertiary Care Centers ; Time Factors ; Treatment Outcome
Keywords
antiarrhythmic drug ; atrial fibrillation ; catheter ablation ; persistent atrial fibrillation ; recurrent event
Abstract
BACKGROUND: Atrial fibrillation (AF) type can vary depending on condition and timing, and some patients who initially present with persistent AF may be changed to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether circumferential pulmonary vein isolation (CPVI) alone is an effective rhythm control strategy in patients with persistent AF to paroxysmal AF. METHODS AND RESULTS: We enrolled 113 patients with persistent AF to paroxysmal AF (male 75%, 60.4±10.1 years old) who underwent catheter ablation for nonvalvular AF at 3 tertiary hospitals. The participants were randomly assigned to 2 groups: CPVI alone (n=59) or CPVI plus linear ablation (CPVI+Line; posterior box+anterior line, n=54). Compared with the CPVI+Line, CPVI alone required shorter procedure (187.2±58.0 versus 211.2±63.9 min; P=0.043) and ablation times (4922.1±1110.5 versus 6205.7±1425.2 s; P<0.001) without difference in procedure-related major complication (3% versus 2%; P=0.611). Antiarrhythmic drug utility rates after ablation were not different between the 2 groups (22% versus 30%; P=0.356). Overall, AF-free survival (log-rank; P=0.206) and AF and antiarrhythmic drug-free survival (log-rank; P=0.321) were not different between groups. CONCLUSIONS: CPVI alone is an effective rhythm control strategy with a shorter procedure time in persistent AF patients converted to paroxysmal AF compared with CPVI with linear ablation.
Full Text
http://circep.ahajournals.org/content/10/6/e004915.long
DOI
10.1161/CIRCEP.116.004915
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, In-Soo(김인수) ORCID logo https://orcid.org/0000-0003-2801-5514
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
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
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
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/22282913/160309
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