Related Experiment Video
Updated: May 12, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Results from a single-blind, randomized study comparing the impact of different ablation approaches on long-term
Sanghamitra Mohanty1, Prasant Mohanty, Luigi Di Biase
1Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N I-35, Ste 720, Austin, TX 78705, USA.
Insights
Ablation strategies for coexistent atrial fibrillation (AF) and atrial flutter (AFL) impact recurrence and quality of life. AF ablation, alone or with AFL ablation, shows better outcomes than lone AFL ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) and atrial flutter (AFL) often coexist, presenting unique treatment challenges.
- Understanding the optimal ablation strategy is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the efficacy of different ablation strategies in patients with coexistent AF and AFL.
- To assess the impact of ablation on arrhythmia recurrence and quality of life.
Main Methods:
- A randomized controlled trial involving 360 patients with documented AF and AFL.
- Patients were assigned to either AF ablation (with or without AFL ablation) or AFL ablation only.
- Arrhythmia recurrence was monitored via event recording and Holter monitoring; quality of life was assessed using validated questionnaires.
Main Results:
- A significantly lower arrhythmia recurrence rate was observed in the AF ablation groups (64%) compared to the lone AFL ablation group (19%).
- Patients undergoing AF ablation reported significant improvements in quality of life, while those with lone AFL ablation experienced only minor benefits.
- Quality of life improvements directly correlated with freedom from arrhythmia.
Conclusions:
- In patients with coexistent AF and AFL, ablation strategies including AF ablation (either alone or combined with AFL ablation) lead to better outcomes.
- Lone AFL ablation is less effective in managing coexistent AF and AFL, resulting in higher recurrence rates and poorer quality of life.
- This study highlights the direct correlation between arrhythmia freedom and improved quality of life in patients undergoing ablation, particularly in a blinded setting.
Background:
This study examined the impact of different ablation strategies on atrial fibrillation (AF) recurrence and quality of life in coexistent AF and atrial flutter (AFL).
Methods And Results:
Three-hundred sixty enrolled patients with documented AF and AFL were blinded and randomized to group 1, AF±AFL ablation (n=182), or group 2, AFL ablation only (n=178). AF recurrence was evaluated with event recording and 7-day Holter at 3, 6, 9, and 12-month follow-ups. Quality of life was assessed at baseline and at the 12-month follow-up with 4 questionnaires: the Medical Outcome Study Short Form, the Hospital Anxiety and Depression Score, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Of the 182 patients in group 1, 58 (age, 63±8 years; 78% male; left ventricular ejection fraction, 59±8%) had AF+AFL ablation and 124 (age, 61±11 years; 72% male; left ventricular ejection fraction, 59±7%) had AF ablation only. In group 2 (age, 62±9 years; 76% male; left ventricular ejection fraction, 58±10%), only AFL was ablated by achieving bidirectional isthmus conduction block. Baseline characteristics were not different across groups. At 21±9 months of follow-up, 117 in group 1 (64%) and 34 in group 2 (19%) were arrhythmia free (P<0.001). In group 1, scores on most quality-of-life subscales showed significant improvement at follow-up, whereas group 2 patients derived relatively minor benefit.
Conclusions:
In coexistent AF and AFL, lower recurrence rate and better quality of life are associated with AF ablation only or AF+AFL ablation than with lone AFL ablation. Furthermore, quality of life directly correlates with freedom from arrhythmia, as shown in this study for the first time in patients blinded to the procedure.
Clinical Trial Registration:
URL: http://www.clinicaltrial.gov/. Unique identifier: NCT01439386.
