Pulmonary antrum radial-linear ablation for paroxysmal atrial fibrillation: interim analysis of a multicenter trial

Abstract

Background: Substrate abnormality in pulmonary vein (PV) antrum plays a critical role in mechanism of atrial fibrillation (AF). The present study compares the strategy of PV antrum radial-linear (PAR) ablation to encircling PV isolation for paroxysmal AF. Methods and results: A total of 86 patients with paroxysmal AF were randomly assigned to PAR ablation group or PV isolation group. The average procedure time was 161±21 min in PAR ablation group and 199±39 min in PV isolation group (P<0.01). The average fluoroscopy time was 25±5 min in PAR ablation group and 32±9 min in PV isolation group (P<0.001). At 14 (15-12) months of follow-up after single procedure, 31 of 42 (74%) patients in PAR ablation group and 22 of 44 patients (50%) in PV isolation group had no recurrence of AF off antiarrhythmic drug (AAD) (P=0.0249); and 36 of 42 patients (86%) in PAR ablation group and 26 of 44 patients (59%) in PV isolation group had no recurrence of AF with AAD (P=0.006). In addition, PAR ablation resulted in greater reduction of LA diameter than encircling PV isolation. Multivariable Cox regression analysis showed that only ablation strategy was independently associated with AF recurrence (HR, 0.31; 95% CI: 0.12-0.78; P=0.013). No major adverse event related to the procedures occurred. ![Figure][1] ablation patern in CARTO mapping Conclusion: This study suggests that PAR ablation is a potentially effective strategy for treatment of paroxysmal AF warranting further investigation. [1]: pending:yes