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

Ki Woon Kang, Hui Nam Pak, Junbeom Park, Jin Gyu Park, Jae Sun Uhm, Boyoung Joung, Moon Hyoung Lee, Chun Hwang

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 ms2, 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.

Original languageEnglish
Pages (from-to)1738-1745
Number of pages8
JournalEuropace
Volume16
Issue number12
DOIs
Publication statusPublished - 2014 Oct 8

Fingerprint

Atrial Septum
Superior Vena Cava
Pulmonary Veins
Atrial Fibrillation
Prospective Studies
Sick Sinus Syndrome
Recurrence
Catheter Ablation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{8a52679a63c846dc9a89d0e0b7aa34c0,
title = "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",
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 ms2, 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.",
author = "Kang, {Ki Woon} and Pak, {Hui Nam} and Junbeom Park and Park, {Jin Gyu} and Uhm, {Jae Sun} and Boyoung Joung and Lee, {Moon Hyoung} and Chun Hwang",
year = "2014",
month = "10",
day = "8",
doi = "10.1093/europace/euu226",
language = "English",
volume = "16",
pages = "1738--1745",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "12",

}

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. / Kang, Ki Woon; Pak, Hui Nam; Park, Junbeom; Park, Jin Gyu; Uhm, Jae Sun; Joung, Boyoung; Lee, Moon Hyoung; Hwang, Chun.

In: Europace, Vol. 16, No. 12, 08.10.2014, p. 1738-1745.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

T2 - Prospective randomized study

AU - Kang, Ki Woon

AU - Pak, Hui Nam

AU - Park, Junbeom

AU - Park, Jin Gyu

AU - Uhm, Jae Sun

AU - Joung, Boyoung

AU - Lee, Moon Hyoung

AU - Hwang, Chun

PY - 2014/10/8

Y1 - 2014/10/8

N2 - 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 ms2, 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.

AB - 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 ms2, 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.

UR - http://www.scopus.com/inward/record.url?scp=84927644493&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84927644493&partnerID=8YFLogxK

U2 - 10.1093/europace/euu226

DO - 10.1093/europace/euu226

M3 - Article

C2 - 25336668

AN - SCOPUS:84927644493

VL - 16

SP - 1738

EP - 1745

JO - Europace

JF - Europace

SN - 1099-5129

IS - 12

ER -