This study was supported by National Science Council (NSC), Grant No. 99–2628-B-075–007-MY3, 99–2627-B-008–003, joint foundation of CGH and NCU, and NSC support for the Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taiwan (NSC 99–2911-I-008–100).
A Prospective, Randomized Comparison of Modified Pulmonary Vein Isolation Versus Conventional Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation
Article first published online: 15 JUN 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 11, pages 1155–1162, November 2012
How to Cite
LIN, Y.-J., CHANG, S.-L., LO, L.-W., HU, Y.-F., SUENARI, K., LI, C.-H., CHAO, T.-F., CHUNG, F.-P., LIAO, J.-N., HARTONO, B., TSO, H.-W., TSAO, H.-M., HUANG, J.-L., KAO, T. and CHEN, S.-A. (2012), A Prospective, Randomized Comparison of Modified Pulmonary Vein Isolation Versus Conventional Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 23: 1155–1162. doi: 10.1111/j.1540-8167.2012.02379.x
- Issue published online: 13 NOV 2012
- Article first published online: 15 JUN 2012
- Accepted manuscript online: 19 MAY 2012 12:10PM EST
- Manuscript received 23 February 2012; Revised manuscript received 12 April 2012; Accepted for publication 15 May 2012.
- atrial fibrillation;
- autonomic nervous system;
- catheter ablation;
- frequency analysis;
- pulmonary vein isolation
Modified Pulmonary Vein Isolation in AF Ablation. Introduction: Pulmonary vein isolation (PVI) is the primary ablation therapy in patients with atrial fibrillation (AF). We hypothesized that high dominant frequency (DF) sites (AF nests during sinus rhythm [SR]) adjacent to the PV ostia are associated with the atrial substrate that maintains AF, and PVI incorporating the high-frequency AF nests may have a higher efficacy.
Methods and Results: In a prospective and randomized comparison, 126 symptomatic paroxysmal AF patients that underwent PVI were enrolled. We compared the efficacy of a modified PVI (ablation line: 1.0–1.5 cm from the PV ostium with encircling the AF nests [spectral analysis with DF >70 Hz during SR, Group II]) versus the anatomy-guided conventional PVI (Group I). In Group II, the DF value along the PV ostium was lower than 70 Hz after the PVI. The primary endpoint was the freedom from symptomatic atrial arrhythmias after a single procedure. We also followed the autonomic function by a time-domain analysis of the heart rate variability. In both groups, AF nests were observed and electric isolation was successfully obtained in all patients. With a mean duration of 16 ± 6.1 months of follow-up, Group II had a higher single procedure efficacy without drugs (78.7% vs 66.1%, log-rank test: P = 0.02), and fewer repeat procedures (6.6% vs 23%; P = 0.04), as compared to Group I.
Conclusion: PVI incorporating the high frequency AF nests adjacent to the PV ostia had a better single procedure efficacy. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1155–1162, November 2012)