Catheter Versus Surgical Ablation of Atrial Fibrillation After a Failed Initial Pulmonary Vein Isolation Procedure: A Randomized Controlled Trial
Dr. Steinberg reports participation on a research grant supported by Biosense Webster; he serves as consultant/advisory board member for Biosense Webster and Boston Scientific. Other authors: No disclosures.
CLINICAL TRIAL REGISTRATION – URL: http://www.clinicaltrials.gov. Unique identifier: NCT01794416.
Catheter Versus Surgical Ablation
The aim of this prospective randomized study was to compare the efficacy and safety of catheter ablation (CA) versus surgical ablation (SA) in the treatment of paroxysmal and persistent AF after failed initial pulmonary vein isolation procedure.
Methods and Results
Patients with a history of symptomatic AF after a previous failed first ablation procedure were eligible for this study. Patients were randomized to CA (n = 32) or SA (n = 32) redo ablation. The primary endpoint was recurrence of atrial tachyarrhythmia at 1 year of follow-up.
At the 12-month follow-up, 26 (81%) of the 32 SA group patients and 15 (47%) of the 32 CA group were AF/AT-free on no antiarrhythmic drugs (P = 0.004, log-rank test). In patients with PAF, 17 (85%) patients of the 20 in SA group and 10 (56%) patients of the 18 in CA group were AF-free (P = 0.04, log-rank test). In patients with PersAF, 9 (75%) patients of the 12 in SA group and 5 (36%) patients of the 14 in CA group were AF-free (P = 0.04, log-rank test). The number of the serious adverse event in the SA group was significantly higher (1 CA group vs 7 SA group; P = 0.02).
In patients with PAF and PersAF after failed initial CA, SA is superior to CA for maintenance of sinus rhythm, although serious adverse event rate is significantly higher for SA.