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 .
Pulmonary vein triggers play an important role in the initiation of atrial flutter: Initial results from the prospective randomized Atrial Fibrillation Ablation in Atrial Flutter (Triple A) trial.
BACKGROUND The incidence of atrial fibrillation ( AF ) after ablation of a cavotricuspid isthmus (CTI)-dependent atrial flutter ( AFL ) is high . OBJECTIVE The purpose of this study was to test the hypothesis that AFL and AF may be initiated by pulmonary vein triggers . This prospect i ve r and omized trial tested the efficacy of a st and alone pulmonary vein isolation ( PVI ) in patients with AFL but without AF . METHODS Patients with AFL but without documented AF were r and omly assigned to 1 of 3 treatment groups : ( 1 ) antiarrhythmic drugs ( AAD ) , ( 2 ) CTI ablation , or ( 3 ) circumferential PVI . The primary end-point was defined as any recurrent atrial tachyarrhythmia and the secondary end-point as recurrence of AFL . In case of tachyarrhythmia recurrence in the PVI group , a second PVI was performed to close gaps in the ablation lines . RESULTS Of the 60 patients , 17 were r and omized to AAD , 23 to CTI ablation , and 20 to PVI . During follow-up of 1.42 ± 0.83 years , 14 of 17 patients ( 82.4 % ) in the AAD group , 14 of 23 patients ( 60.9 % ) in the CTI group , and 2 of 20 patients ( 10 % ) in the PVI group reached the primary end-point ( P < .001 ) after a mean of 1.4 PVI procedures per patient . AFL reoccurred in 9 patients ( 52.9.% ) in the AAD group , in 2 patients ( 8.7 % ) in the CTI group , and after a single PVI in 3 patients ( 15 % ) in the PVI group ( P = .003 ) . After closure of gaps , 1 patient ( 5 % ) in the PVI group presented with recurrent AFL . CONCLUSION Pulmonary vein triggers play an important role in AFL . PVI can prevent the recurrence of AFL , even without CTI ablation
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 .