Pulmonary vein isolation to reduce future risk of atrial fibrillation in patients undergoing typical flutter ablation: Results from a randomized pilot study (REDUCE AF)

Gemma Pelargonio, Michela Casella, Sanghamitra Mohanty, Andrea Natale, Prasant Mohanty, Luigi Di Biase, Chintan Trivedi, Rong Bai, J. David Burkhardt, G. Joseph Gallinghouse, Rodney Horton, Javier E. Sanchez, Patrick M. Hranitzky, Amin Al-Ahmad, Steven Hao, Richard Hongo, Salwa Beheiry, Giovanni Forleo, Antonio Rossillo, Sakis ThemistoclakisSanjay Dixit

Risultato della ricerca: Contributo in rivistaArticolo in rivista

33 Citazioni (Scopus)

Abstract

Benefits of PVI in Patients with Atrial Flutter Background This study examined incidence of AF following cavotricuspid isthmus (CTI) ablation alone or CTI plus prophylactic pulmonary vein isolation (PVI) in patients presenting with isolated atrial flutter (AFL) with no history of AF. Methods and Results We enrolled 216 patients with isolated typical atrial flutter and randomized them to CTI alone (group 1, n = 108, 61.2 ± 9.7 year, 75% male) or CTI+PVI ablation (group 2, n = 108, 62.4 ± 9.3 year, 73% male). Insertible loop recorder (ILR) was implanted in 21 and 19 patients from groups 1 and 2, respectively. Remaining patients were monitored with event recorders, ECG, 7-day Holter. Follow-up period was for 18 ± 6 months. Compared to group 1, group 2 had significantly longer procedural duration (75.9 ± 33 min vs. 161 ± 48 min [P < 0.001]) and fluoroscopy time (15.9 ± 12.3 min vs. 56.4+21 min [P < 0.001]). At the end of follow-up, 65 (60.2%) in group 1 and 77 (71.3%) in group 2 were arrhythmia free off-AAD (log-rank P = 0.044). A subgroup analysis was performed with 55 year age cut-off. In the <55 age group the CTI only population had similar success as in CTI+PVI, (21 of 24 [83.3%] vs. 19 of 22 [86.4%], respectively, log-rank P = 0.74). In the ≥55 group, having CTI+PVI showed significantly higher success compared to CTI only; 45 of 84 (53.6%) were AF/AT free in CTI only group versus 58 of 86 (67.4%) with CTI+PVI (log-rank P = 0.029). Conclusion Prophylactic PVI reduced new-onset AF in patients with lone atrial flutter.
Lingua originaleEnglish
pagine (da-a)819-825
Numero di pagine7
RivistaJournal of Cardiovascular Electrophysiology
Volume26
DOI
Stato di pubblicazionePubblicato - 2015

Keywords

  • Action Potentials
  • Aged
  • Atrial Fibrillation
  • Atrial Flutter
  • Catheter Ablation
  • Disease-Free Survival
  • Electrocardiography, Ambulatory
  • Female
  • Heart Rate
  • Humans
  • Incidence
  • Italy
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Pilot Projects
  • Proportional Hazards Models
  • Pulmonary Veins
  • Risk Factors
  • Telemetry
  • Time Factors
  • Treatment Outcome
  • United States
  • cavotricuspid isthmus ablation
  • new-onset atrial fibrillation
  • outcome
  • prophylactic pulmonary vein isolation
  • typical atrial flutter

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