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Autonomic Denervation Added to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: A Randomized Clinical Trial

Journal of the American College of Cardiology, 2013-12, Vol.62 (24), p.2318-2325 [Peer Reviewed Journal]

2015 INIST-CNRS ;Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2013.06.053 ;PMID: 23973694 ;CODEN: JACCDI

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  • Title:
    Autonomic Denervation Added to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: A Randomized Clinical Trial
  • Author: KATRITSIS, Demosthenes G ; POKUSHALOV, Evgeny ; ROMANOV, Alexander ; GIAZITZOGLOU, Eleftherios ; SIONTIS, George C. M ; PO, Sunny S ; CAMM, A. John ; IOANNIDIS, John P. A
  • Subjects: Ablation Techniques ; Adult ; Aged ; Atrial Fibrillation - surgery ; Autonomic Denervation - methods ; Electrophysiologic Techniques, Cardiac ; Female ; Ganglia, Autonomic - diagnostic imaging ; Ganglia, Autonomic - surgery ; Heart Atria - innervation ; Humans ; Male ; Middle Aged ; Pulmonary Veins - surgery ; Tachycardia, Paroxysmal - surgery ; Tomography, Spiral Computed
  • Is Part Of: Journal of the American College of Cardiology, 2013-12, Vol.62 (24), p.2318-2325
  • Description: The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Conventional PVI transects the major left atrial GP, and it is possible that autonomic denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p < 0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered. Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.
  • Publisher: New York, NY: Elsevier
  • Language: Russian;English
  • Identifier: ISSN: 0735-1097
    EISSN: 1558-3597
    DOI: 10.1016/j.jacc.2013.06.053
    PMID: 23973694
    CODEN: JACCDI
  • Source: GFMER Free Medical Journals
    MEDLINE
    Alma/SFX Local Collection
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