Background: Previous studies suggest that wide area circumferential
pulmonary vein ablation (WACA) is more effective than segmental
pulmonary vein ablation (SPVA) for pulmonary vein isolation (PVI) for
treatment of atrial fibrillation. Whether this is true in patients (pts)
with very short duration paroxysmal atrial fibrillation (PAF) is
unknown. Objective: To compare WACA to SPVA in pts with PAF lasting
<48 hours. Methods: One hundred pts with PAF <48
hours were randomized to either WACA vs SPVA (45 and 53 pts
respectively, with 2 withdrawals), and followed up for 24 months with
14-day ECGs every 6 months. Results: Among 97 pts at an average of
22.1±4.8 months followup, 26 (57.8%) remained free of any atrial
arrhythmias after WACA versus 29 (55.86%) after SPVA (p=0.64). Sixteen
pts (35.6%) had recurrent PAF after WACA versus 20 pts (38.5%) after
SPVA (p=0.79). Seven pts (15.6%) had atrial flutter after WACA versus 5
pts (9.64%) after SPVA (p=0.376) and 1 pt (2.2%) had atrial
tachycardia after WACA vs 1 pt (1.9%) after SPVA (p=0.918). Total
procedure time was lower for SPVA vs WACA (242.9 vs 271.1 minutes, p=
0.047), and fluoroscopy time similar for WACA vs SPVA (50.8 vs 53.4
minutes, p=0.555). Conclusions: As an initial ablation approach in pts
with PAF <48 hours, SPVA was similarly effective to WACA with
respect to arrhythmia recurrence, supporting the central role of the
pulmonary veins for maintaining AF in these pts. Future therapies using
alternative ablation energies may incorporate these insights to reduce
risk to gastroesophageal structures.
Stepwise ablation approach versus pulmonary vein isolation in patients with paroxysmal atrial fibrillation: Randomized controlled trial
