Pulmonary Vein Isolation Versus Defragmentation
Open accessAbstract
Background Long-term success rates using ablation for persistent atrial fibrillation (AF) are disappointing and usually do not exceed 60%.Objectives This study sought to compare arrhythmia-free survival between pulmonary vein isolation (PVI) and a stepwise approach (full defrag) consisting of PVI, ablation of complex fractionated electrograms, and additional linear ablation lines in the setting of atrial tachycardias (AT) in patients with persistent AF after PVI.Methods From November 2010 to February 2013, 205 patients (151 men; 61.7 ± 10.2 years of age) underwent de novo ablation for persistent AF. Subsequently, patients were prospectively randomized to either PVI alone (n = 78) or full defrag (n = 75), with 52 patients not randomized due to AF termination with the original PVI. The primary endpoint was recurrence of any AT after a blanking period of 3 months.Results During the entire study, 241 ablations were performed (mean: 1.59 in the PVI-alone group, 1.55 in the full-defrag group). With the stepwise approach, termination of AF occurred in 45 (60%) patients. However, arrhythmia-free survival did not differ whether patients underwent single or multiple procedures (p = 0.468). Procedure duration, fluoroscopy time, and radiofrequency duration were significantly longer in the full-defrag group (all p < 0.001).Conclusions A stepwise approach aimed at AF termination does not seem to provide additional benefit over PVI alone in patients with persistent AF, but it is associated with significantly longer procedural and fluoroscopic duration as well as radiofrequency application time. (The Randomized Catheter Ablation of Persist End Atrial Fibrillation Study [CHASE-AF]; NCT01580124).
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Extensive left atrial ablation beyond pulmonary vein isolation carries a potentially increased risk of macroreentrant or focal iatrogenic atrial tachycardias, and its value is not well established in patients with paroxysmal or persistent atrial fibrillation.
“However, these techniques carry a potentially increased risk of macroreentrant or focal iatrogenic atrial tachycardias, 197,207 and their value is rather not established in patients with paroxysmal or persistent AF. 208 -210”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [210]
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Retracted
- Authors
- Vogler, J., Willems, S., Sultan, A., Schreiber, D., Lüker, J., Servatius, H., Schäffer, B., Moser, J., Hoffmann, B. A., & Steven, D.
- Affiliations
- Universität Hamburg (DE)
- University of Cologne (DE)
- Klinik Hirslanden (CH)
- University of Bern (CH)
- Corresponding author
- Vogler, Julia
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 66
- Issue
- 24
- Pages
- 2743-2752
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2203499036
- Cited by
- 349
- References
- 39
- Citations by year
- 2026: 22 · 2025: 32 · 2024: 31 · 2023: 24 · 2022: 41 · 2021: 27 · 2020: 36 · 2019: 35 · 2018: 30 · 2017: 43 · 2016: 26 · 2015: 1
- FWCI
- 24.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- pulmonary vein isolation, persistent atrial fibrillation, complex fractionated electrograms, atrial tachycardia recurrence, arrhythmia-free survival, catheter ablation, radiofrequency ablation, procedure time, fluoroscopy time
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Atrial Fibrillation, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Veins, Recurrence, Time Factors, Treatment Outcome, Catheter Ablation, Electrophysiologic Techniques, Cardiac, Young Adult
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