Превентивная изоляция легочных вен у пациентов с аблацией кавотрикуспидального перешейка исследование prevent Af study I

Abstract

Background. Although catheter ablation of isthmus-dependent atrial flutter (AFL) is extremely successful at eliminating the target arrhythmia, many patients subsequently experience a new onset of atrial fibrillation (AF) due to shared mechanisms. The development of AF may necessitate additional interventions and expose patients to long-term risks. Objective. The study was designed to test a hypothesis whether it is possible to keep AF down during cavotricuspid isthmus (CTI) ablation. Methods. This prospective blind randomized study included 50 patients with detected AFL, without AF in the medical history. The patients were randomized to undergo either CTI ablation alone or CTI with concomitant pulmonary vein isolation (PVI). All patients received an implantable loop recorder (ILR) during the ablation procedure. Results. CTI ablation was successful in all 50 patients. PVI was effective in all 25 patients randomized to CTI+PVI group, with no complications recorded in both groups. The procedure (p<0.0001) and fluoroscopy (p<0.0001) times were longer in the CTI+PVI group. More patients in the CTI alone group experienced a new onset of AF, 52% vs 12%, during follow-up for minimum of one year (p=0.005). No patient experienced recurrent AFL. The one-year AF burden on ILR also favored the CTI+PVI group compared to the CTI alone group: 8.3% vs 4.0% (p=0.034). In the CTI alone group, 32% patients subsequently required another ablation for AF. PVI and female gender proved to be independent predictors of freedom from AF. Conclusions. The PREVENT-AF Study I trial results show that the addition of PVI to CTI ablation for patients with typical AFL only leads to a marked reduction of a new onset of AF during clinical follow-up as assessed by implantable ILR.