No Added Benefits for Full-Defrag Ablation for AF

A stepwise approach to ablation for persistent atrial fibrillation (AF) does not offer any benefits over pulmonary vein isolation (PVI) alone, according to a new study.

Researchers at University Medical Center Hamburg-Eppendorf (UKE; Germany), University Hospital Cologne (Germany), and other institutions conducted a study involving 205 patients (151 men; mean age 61.7 years) who underwent de novo ablation for persistent AF. Subsequently, the patients were prospectively randomized to either PVI alone (78 patients), or full defragmentation ablation (75 patients), consisting of PVI, ablation of complex fractionated electrograms, and additional linear ablation lines. The remaining 52 patients were not randomized due to AF termination with the original PVI.

The primary endpoint of the study was recurrence of any atrial tachycardia (AT) after a blanking period of three months. The results showed that during the entire study, 241 ablations were performed. At 12 months, the incidence of AT was similar between recipients of PVI alone and those who underwent full defragmentation (8.2% versus 8.5%, respectively). Arrhythmia-free survival rates were also similar between groups, at 63.9% with PVI only and 57.7% with full defragmentation.

The researchers also found, conversely, that despite the fact that the rate of major complications did not differ materially between groups, the full defragmentation arm suffered a 23.3% incidence of pericardial effusion with symptoms of pericarditis, compared with a much lower 5.3% incidence in their single-procedure counterparts. The study was published on December 22, 2015, in the Journal of the American College of Cardiology.

“Pulmonary vein isolation should be the initial strategy in patients with persistent AF undergoing catheter ablation, because more extensive ablation is associated with longer procedure duration, fluoroscopy, and radiofrequency exposure, without better rhythm control outcomes,” concluded lead author Julia Vogler, MD, of University Heart Center Hamburg, and colleagues. She added, however, that “pulmonary vein isolation alone appears to be insufficient for treating persistent AF, with disappointing long-term results.”

PVI is a catheter ablation technique developed to prevent focal triggers in the pulmonary veins from initiating episodes of AF. Although the procedure initially involved focal ablation with a catheter directly in the pulmonary veins, isolating the pulmonary veins by applying ablation energy at their junction with the left atrium is more effective. The PVI procedure is most suitable for patients whose recurring symptomatic episodes of AF have not been suppressed by anti-arrhythmic drugs, or who do not wish to take long-term anti-arrhythmic or anticoagulation medications.

Related Links:
University Medical Center Hamburg-Eppendorf
University Hospital Cologne