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Electrical Posterior Box Isolation in Persistent Atrial Fibrillation Changed to Paroxysmal Atrial Fibrillation: A Multicenter, Prospective, Randomized Study

Authors
 Hui-Nam Pak  ;  Junbeom Park  ;  Je-Wook Park  ;  Song-Yi Yang  ;  Hee Tae Yu  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Jong-Il Choi  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Young-Hoon Kim  ;  Jaemin Shim 
Citation
 CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, Vol.13(9) : e008531, 2020-09 
Journal Title
 CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY 
ISSN
 1941-3149 
Issue Date
2020-09
Keywords
atrial fibrillation ; catheter ablation ; follow-up studies ; pulmonary veins ; recurrence
Abstract
Background: Persistent atrial fibrillation (AF) can change to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient groups. Methods: We prospectively randomized 114 patients with persistent AF to paroxysmal AF (men, 75%; 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). Primary end point was AF recurrence after a single procedure, and secondary end points were recurrence pattern, cardioversion rate, and response to antiarrhythmic drugs. Results: After a mean follow-up of 23.8±10.2 months, the clinical recurrence rate did not significantly differ between the CPVI alone and additional POBI group (31.6% versus 28.1%; P=0.682; log-rank P=0.729). The recurrences as atrial tachycardias (5.3% versus 12.3%; P=0.134) and cardioversion rates (5.3% versus 10.5%; P=0.250) were not significantly different between the CPVI and POBI groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% of CPVI group and 59.6% of POBI group (P=0.450). No significant difference was found in major complication rates between the two groups (5.3% versus 1.8%; P=0.618), but the total ablation time was significantly longer in the POBI group (4187±952 versus 5337±1517 s; P<0.001). Conclusions: In patients with persistent AF converted to paroxysmal AF by antiarrhythmic drug, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation or influence overall safety, while leading to longer ablation time. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02176616.
Full Text
https://www.ahajournals.org/doi/full/10.1161/CIRCEP.120.008531
DOI
10.1161/CIRCEP.120.008531
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Park, Je Wook(박제욱)
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/22282913/180509
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