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Prophylactic cavotricuspid isthmus block during atrial fibrillation ablation in patients without atrial flutter: a
J Pontoppidan1, J C Nielsen, S H Poulsen
1Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. pontoppidan@dadlnet.dk
Insights
Adding prophylactic cavotricuspid isthmus block (CTIB) to pulmonary vein ablation (CPVA) did not reduce atrial flutter (AFL) or atrial fibrillation (AF) recurrence. Most patients with AF or AFL recurrences after ablation remained asymptomatic.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Interventions
Background:
- Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias.
- Circumferential pulmonary vein ablation (CPVA) is a standard treatment for AF.
- The role of prophylactic cavotricuspid isthmus block (CTIB) in addition to CPVA for patients without prior AFL is not well-defined.
Purpose of the Study:
- To evaluate the benefit of adding prophylactic CTIB to CPVA in patients with AF and no history of AFL.
- To assess the impact on AF and AFL recurrence rates after 12 months of follow-up.
Main Methods:
- A randomized trial involving 149 patients with AF (54% paroxysmal).
- Patients were randomized to CPVA with CTIB (n=73) or CPVA alone (n=76).
- Follow-up included repetitive 7-day Holter monitoring at 3, 6, and 12 months.
Main Results:
- No significant difference in cumulative AFL-free rates (88% vs 84%, p=0.61) or AF-free rates (34% vs 32%, p=0.71) between groups.
- Six patients (4%) experienced cardiac tamponade, and one had a stroke.
- 33% of patients were AF-free after a single procedure; 62% showed benefit after 12 months including reprocedures.
Conclusions:
- Prophylactic CTIB added to CPVA did not demonstrate a beneficial effect on AF or AFL recurrence.
- A 33% rate of freedom from AF was observed over 1 year with repetitive Holter monitoring.
- A clinical effect was noted in 62% of patients at 12 months, with many recurrences being asymptomatic.
Objectives:
This randomised trial evaluated if patients with atrial fibrillation (AF) and no history of atrial flutter (AFL) had any benefit of prophylactic cavotricuspid isthmus block (CTIB) in addition to circumferential pulmonary vein ablation (CPVA).
Methods:
149 patients with AF (54% paroxysmal) were randomised to CPVA and CTIB (group CTIB+, n = 73) or CPVA alone (group CTIB-, n = 76). Patients were followed for 12 months with repetitive 7-day Holter monitoring after 3, 6 and 12 months.
Results:
Six patients (4%) had cardiac tamponade, and one patient had a stroke. No difference was found in the cumulative AFL-free rate between the two treatment groups (CTIB+: 88% vs CTIB-: 84%, hazard ratio (HR) 0.80, 95% CI (0.34 to 1.90), p = 0.61). There was no difference in the cumulative AF-free rate between the groups (CTIB+: 34% vs CTIB-: 32%, HR 0.93, 95% CI (0.63 to 1.38), p = 0.71). Overall, 33% of the patients were free of AF after a single procedure. Including reprocedures, a complete or partial beneficial effect was noted in 62% of the patients at 12 months. At 12-month follow-up, 24 (50%) patients with documented AF or AFL in the Holter recordings were asymptomatic.
Conclusions:
It was not possible to demonstrate any beneficial effect of CTIB in addition to CPVA with regard to AFL or AF recurrences during follow-up. Repetitive long-term Holter monitoring demonstrated a 33% rate of freedom from AF during a 1-year follow-up. Including additional CPVA procedures, a clinical effect was noted in 62% of the patients at 12 months. Patients with AF or AFL recurrences were often asymptomatic.
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