In people with non-paroxysmal atrial fibrillation , evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias , reducing the need for cardioversion , and reducing cardiac-related hospitalisations .
BACKGROUND The optimal rhythm management strategy for people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrilation is currently not well defined .
Antiarrhythmic drugs have been the mainstay of therapy .
But recently , in people who have not responded to antiarrhythmic drugs , the use of ablation ( catheter and surgical ) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications .
However , evidence from r and omised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited .
OBJECTIVES To determine the efficacy and safety of ablation ( catheter and surgical ) in people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrillation compared to antiarrhythmic drugs .
Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison.
BACKGROUND The optimal ablation technique for persistent and long-st and ing persistent atrial fibrillation ( AF ) is unclear . Both linear lesion ( LL ) and ganglionated plexus ( GP ) ablation have been used in addition to pulmonary vein isolation ( PVI ) , but no direct comparison of the 2 methods exists . OBJECTIVE The aim of this study is to assess the comparative safety and efficacy of 2 different ablation strategies-PVI+LL vs PVI+GP ablation -in patients with persistent or long-st and ing persistent AF . METHODS Two hundred sixty-four consecutive patients with persistent/long-st and ing persistent AF were r and omly assigned to 2 different ablation schemes : PVI+LL ( n = 132 ) and PVI+GP ( n = 132 ) ablation . Consistent sinus rhythm ( SR ) off antiarrhythmic drug was assessed after follow-up of at least 3 years with the use of an implanted monitoring device . RESULTS All procedural end points were acutely achieved . At 12 months after a single procedure , 47 % of the patients treated with PVI+LL were in SR compared to 54 % of the patients treated with PVI+GP ( P = .29 ) . At 3 years , 34 % of the patients with PVI+LL and 49 % of the patients with PVI+GP maintained SR ( P = .035 ) . Atrial flutter was more frequent in the PVI+LL group than in PVI+GP group ( 18 % vs 6 % ; P = .002 ) . After a second procedure in 78 patients of the PVI+LL group and 55 patients of the PVI+GP group , the long-term overall success rate was 52 % and 68 % , respectively ( P = .006 ) . CONCLUSIONS PVI+GP ablation confers superior clinical results with less ablation-related left atrial flutter and reduced AF recurrence compared to PVI+LL ablation at 3 years of follow-up
In people with non-paroxysmal atrial fibrillation , evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias , reducing the need for cardioversion , and reducing cardiac-related hospitalisations .
BACKGROUND The optimal rhythm management strategy for people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrilation is currently not well defined .
Antiarrhythmic drugs have been the mainstay of therapy .
But recently , in people who have not responded to antiarrhythmic drugs , the use of ablation ( catheter and surgical ) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications .
However , evidence from r and omised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited .
OBJECTIVES To determine the efficacy and safety of ablation ( catheter and surgical ) in people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrillation compared to antiarrhythmic drugs .