Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring

• Published in: Journal of cardiovascular electrophysiology 2018-08, Vol.29 (8), p.1073-1080
• Main Authors: Jan, Matevž, Žižek, David, Geršak, Živa Miriam, Geršak, Borut
• Format: Article
• Language: English
• Subjects: Ablation; Arrhythmia; atrial fibrillation; Blanking; Cardiac arrhythmia; catheter ablation; Catheters; Complications; convergent procedure; Fibrillation; Medical instruments; Patients; pulmonary vein isolation; Radiofrequency ablation; Randomization; surgical ablation; Tachycardia
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.13625

Introduction While catheter ablation (CA) is an established treatment for symptomatic paroxysmal atrial fibrillation (AF), convergent epicardial and endocardial ablation procedure (CVP) has been primarily used to treat persistent AF. The aim of this single‐center, prospective, randomized study was to compare treatment efficacy of CA and CVP in paroxysmal AF patients by monitoring AF, atrial tachycardia (AT), and atrial flutter (AFL) recurrence with Implantable Loop Recorder (ILR). Methods and results Fifty patients (74% male) with history of paroxysmal AF were randomized between CA and CVP. Outcomes were determined by ILRs; every episode of AF/AT/AFL lasting 6 minutes or more was defined as a recurrence. AF burden (AFB) and required AF reinterventions (cardioversions and repeat ablations) were quantified after a 3‐month blanking period. Total procedural (266 ± 44 vs. 242 ± 39 minutes) and ablation duration (52 ± 10 vs. 48 ± 12 minutes) was similar in both groups. Recurrence of AF/AT/AFL was more likely in the CA group compared to the CVP group (OR 3.78 (95% CI (1.17, 12.19), P  =  0.048)). During the follow‐up period (mean 30.5 ± 6.9 months), higher AF burden and more reinterventions for recurrent AF were recorded in the CA group. There were more periprocedural complications in the CVP group (12.5%) compared to the CA group (0%). Conclusion Treatment of paroxysmal AF with CVP showed less arrhythmia recurrence compared to CA. In addition, patients after CVP had fewer reinterventions and lower AF burden, but more periprocedural complications.