Author + information
- Changsheng Ma,
- Hung-Fat Tse,
- Cai-Hua Sang,
- Rong-Hui Yu,
- De-Yong Long,
- Ri-Bo Tang,
- Chen-Xi Jiang,
- Xing-Peng Liu,
- Xin Du and
- Jian-Zeng Dong
Stepwise approach is effective for catheter ablation of persistent atrial fibrillation (AF). However, its complexity limits its wide application. We sought to compare the clinical efficacy of a fixed approach named “2C3L”, which consists of bilateral circumferential pulmonary vein antrum (CPVA) and three linear atrial ablations versus stepwise approach in patients with persistent AF.
We randomized 146 patients (age 55±11 years, 76% men) with persistent AF (>3 months) to undergo 2C3L (n=73) or stepwise (n=73) approach from August 2009 to January 2011. In both groups, initial CPVA and linear ablation at the left atrial roof, mitral isthmus and cavotricuspid isthmus were performed. In the 2C3L group, cardioversion was applied and further ablation was performed to achieve conduction block over CPVA and 3 lines. In the stepwise group, ablation of complex fractionated atrial electrograms was performed to achieve AF termination, and all organized atrial tachycardias (OATs) were mapped and ablated. Further ablation was performed to achieve conduction block over CPVA and the 3 lines. The primary end point was freedom from any atrial tachyarrhythmia off antiarrhythmic drugs at 12 months follow-up.
There were no significant differences in the demographic features, duration of AF, left ventricular ejection fraction and left atrial dimension between the 2 groups (p>0.05). The procedural (222±42 vs. 268±43 min), fluoroscopy (41±9 vs. 55±8 min), and ablation (107±32 vs. 128±38 min) durations were shorter and the AF termination rate was lower (21 vs. 53%) with 2C3L than stepwise approach (all p<0.001). Success rates to achieve complete conduction block over CPVA and the 3 lines were similar between the 2 groups (p>0.05). At 12 months, there was no significant difference in the prevalence of sinus rhythm after 2C3L approach (49/73, 67%) vs. stepwise approach (44/73, 60%) without any AAD, (p=0.28). Furthermore, there were no differences in the AF recurrence rate (10 %vs. 11%) or OATs (23% vs. 29%) between the 2 groups (p>0.05).
The “2C3L” strategy is a simplified with similar clinical efficacy as stepwise approach for catheter ablation of persistent AF.
Oral Contributions West, Room 2006
Sunday, March 10, 2013, Noon-12:15 p.m.
Session Title: The Invasive Approach to the Management of Atrial Fibrillation
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 923-8
- 2013 American College of Cardiology Foundation