We observed statistically significantly better AT recurrence-free survival with CPVA than with ADT .
BACKGROUND Circumferential pulmonary vein ablation ( CPVA ) has become common therapy for atrial fibrillation ( AF ) , but results of large r and omized controlled trials comparing this procedure with antiarrhythmic drug therapy ( ADT ) have not been published to date .
We conducted a systematic literature review to assess whether CPVA is superior to ADT for the management of AF .
Prevention of Iatrogenic Atrial Tachycardia After Ablation of Atrial Fibrillation: A Prospective Randomized Study Comparing Circumferential Pulmonary Vein Ablation With a Modified Approach
Background —Circumferential pulmonary vein ablation ( CPVA ) is effective in curing  atrial fibrillation ( AF ) , but new-onset left atrial tachycardia ( AT ) is a potential complication . We evaluated whether a modified CPVA approach including additional ablation lines on posterior wall and the mitral isthmus would reduce the incidence of AT after PV ablation . Methods and Results —A total of 560 patients ( 291 men , 52 % ; age , 56.5±7.3 years ) entered the study ; 280 were r and omized to CPVA alone ( group 1 ) and 280 to modified CPVA ( group 2 ) . The primary end point was freedom from AT after the procedure . In group 1 , 28 patients ( 10 % ) experienced new-onset AT , and 41 ( 14.3 % ) experienced recurrent AF . In group 2 , 11 patients ( 3.9 % ) experienced AT , and 36 ( 12.9 % ) had recurrent AF . Group 1 was more likely to experience AT than group 2 ( P=0.005 ) . Freedom from AF after ablation was similar in both groups ( P=0.57 ) . Among those in group 1 , gap-related macroreentrant AT was documented in 23 of the 28 patients ( 82 % ) , and focal AT was found in 5 ( 18 % ) . In group 2 , gap-related macroreentrant AT was found in 8 of the 11 patients ( 73 % ) , and focal AT was seen in 3 ( 27 % ) . Two patients in group 1 and 1 patient in group 2 had both AT and AF . The strongest predictor of AT was the presence of gaps ( P<0.001 ) . Conclusions —Modified CPVA is as effective as CPVA in preventing AF but is associated with a lower risk of developing incessant AT
We observed statistically significantly better AT recurrence-free survival with CPVA than with ADT .
BACKGROUND Circumferential pulmonary vein ablation ( CPVA ) has become common therapy for atrial fibrillation ( AF ) , but results of large r and omized controlled trials comparing this procedure with antiarrhythmic drug therapy ( ADT ) have not been published to date .
We conducted a systematic literature review to assess whether CPVA is superior to ADT for the management of AF .