A minimal or maximal ablation strategy to achieve pulmonary vein isolation for paroxysmal atrial fibrillation: a prospective multi-centre randomized controlled trial (the Minimax study)
| Autor: | Prashanthan Sanders, Michael C.G. Wong, Peter M. Kistler, Joseph B. Morton, Nigel Lever, Liang-Han Ling, Geraldine Lee, Karen Halloran, Khang-Li Looi, Justin M.S. Lee, Sonia Azzopardi, Saurabh Kumar, Simon P. Fynn, Geoffrey Lee, Jonathan M. Kalman, Martin K. Stiles, Patrick M. Heck, Tomos E. Walters, Alex J.A. McLellan |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Radiofrequency ablation medicine.medical_treatment Catheter ablation Pulmonary vein law.invention Randomized controlled trial Recurrence law Internal medicine Atrial Fibrillation medicine Humans Prospective Studies Prospective cohort study medicine.diagnostic_test business.industry Atrial fibrillation Middle Aged medicine.disease Ablation Surgery Treatment Outcome Pulmonary Veins Catheter Ablation Electrocardiography Ambulatory Cardiology Female Cardiology and Cardiovascular Medicine business Anti-Arrhythmia Agents Electrocardiography |
| Zdroj: | European Heart Journal. 36:1812-1821 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehv139 |
| Popis: | Aims Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF). The intervenous ridge (IVR) may be incorporated into ablation strategies to achieve PVI; however, randomized trials are lacking. We performed a randomized multi-centre international study to compare the outcomes of (i) circumferential antral PVI (CPVI) alone ( minimal ) vs. (ii) CPVI with IVR ablation to achieve individual PVI ( maximal ). Methods and results Two hundred and thirty-four patients with paroxysmal AF underwent CPVI and were randomized to a minimal or maximal ablation strategy. The primary outcome of recurrent atrial arrhythmia was assessed with 7-day Holter monitoring at 6 and 12 months. PVI was achieved in all patients. Radiofrequency ablation time was longer in the maximal group (46.6 ± 14.6 vs. 41.5 ± 13.1 min; P < 0.01), with no significant differences in procedural or fluoroscopy times. At mean follow-up of 17 ± 8 months, there was no difference in freedom from AF after a single procedure between a minimal (70%) and maximal ablation strategy (62%; P = 0.25). In the minimal group, ablation was required on the IVR to achieve electrical isolation in 44%, and was associated with a significant reduction in freedom from AF (57%) compared with the minimal group without IVR ablation (80%; P < 0.01). Conclusion There was no statistically significant difference in freedom from AF between a minimal and maximal ablation strategy. Despite attempts to achieve PVI with antral ablation, IVR ablation is commonly required. Patients in whom antral isolation can be achieved without IVR ablation have higher long-term freedom from AF (the Minimax study; ACTRN12610000863033). |
| Databáze: | OpenAIRE |
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