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

13 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

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

  • Cite this