Randomized Ablation Strategies for the Treatment of Persistent Atrial Fibrillation RASTA Study

被引:190
作者
Dixit, Sanjay [1 ]
Marchlinski, Francis E. [1 ]
Lin, David [1 ]
Callans, David J. [1 ]
Bala, Rupa [1 ]
Riley, Michael P. [1 ]
Garcia, Fermin C. [1 ]
Hutchinson, Mathew D. [1 ]
Ratcliffe, Sarah J. [2 ]
Cooper, Joshua M. [1 ]
Verdino, Ralph J. [1 ]
Patel, Vickas V. [1 ]
Zado, Erica S. [1 ]
Cash, Nancy R. [1 ]
Killian, Tony [1 ]
Tomson, Todd T. [1 ]
Gerstenfeld, Edward P. [1 ]
机构
[1] Hosp Univ Penn, Div Cardiovasc, Philadelphia, PA 19104 USA
[2] Univ Penn, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA
关键词
ablation; atrial fibrillation; catheter ablation; clinical trials; CATHETER ABLATION; ELECTROGRAMS; EFFICACY;
D O I
10.1161/CIRCEP.111.966226
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF. Methods and Results-Subjects were randomized as follows: arm 1, PVI + ablation of non-PV triggers identified using a stimulation protocol (standard approach); arm 2, standard approach + empirical ablation at common non-PV AF trigger sites (mitral annulus, fossa ovalis, eustachian ridge, crista terminalis, and superior vena cava); or arm 3, standard approach + ablation of left atrial complex fractionated electrogram sites. Patients were seen at 6 weeks, 6 months, and 1 year; transtelephonic monitoring was performed at each visit. Antiarrhythmic drugs were discontinued at 3 to 6 months. The primary study end point was freedom from atrial arrhythmias off antiarrhythmic drugs at 1 year after a single-ablation procedure. A total of 156 patients (aged 59 +/- 9 years; 136 males; AF duration, 47 +/- 50 months) participated (arm 1, 55 patients; arm 2, 50 patients; arm 3, 51 patients). Procedural outcomes (procedure, fluoroscopy, and PVI times) were comparable between the 3 arms. More lesions were required to target non-PV trigger sites than a complex fractionated electrogram (33 +/- 9 versus 22 +/- 9; P<0.001). The primary end point was achieved in 71 patients and was worse in arm 3 (29%) compared with arm 1 (49%; P=0.04) and arm 2 (58%; P=0.004). Conclusions-These data suggest that additional substrate modification beyond PVI does not improve single-procedure efficacy in patients with persistent AF. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00379301. (Circ Arrhythm Electrophysiol. 2012;5:287-294.)
引用
收藏
页码:287 / 294
页数:8
相关论文
共 15 条
[1]   HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for personnel, policy, procedures and follow-up [J].
Calkins, Hugh ;
Brugada, Josep ;
Packer, Douglas L. ;
Cappato, Riccardo ;
Chen, Shih-Ann ;
Crijns, Harry J. G. ;
Damiano, Ralph J., Jr. ;
Davies, D. Wyn ;
Haines, David E. ;
Haissaguerre, Michel ;
Iesaka, Yoshito ;
Jackman, Warren ;
Jais, Pierre ;
Kottkamp, Hans ;
Kuck, Karl Heinz ;
Lindsay, Bruce D. ;
Marchlinski, Francis E. ;
McCarthy, Patrick M. ;
Mont, J. Lluis ;
Morady, Fred ;
Nademanee, Koontawee ;
Natale, Andrea ;
Pappone, Carlo ;
Prystowsky, Eric ;
Raviele, Antonio ;
Ruskin, Jeremy N. ;
Shemin, Richard J. .
HEART RHYTHM, 2007, 4 (06) :816-861
[2]   Diagnostic accuracy of a new software for complex fractionated electrograms identification in patients with persistent and permanent atrial fibrillation [J].
Calo, Leonardo ;
De Ruvo, Ermenegildo ;
Sciarra, Luigi ;
Gricia, Roberto ;
Navone, Giovanna ;
De Luca, Lucia ;
Nuccio, Francesca ;
Sette, Antonella ;
Pristipino, Cristian ;
Dulio, Alessandro ;
Gaita, Fiorenzo ;
Lioy, Ernesto .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2008, 19 (10) :1024-1030
[3]   Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation [J].
Cappato, Riccardo ;
Calkins, Hugh ;
Chen, Shih-Ann ;
Davies, Wyn ;
Iesaka, Yoshito ;
Kalman, Jonathan ;
Kim, You-Ho ;
Klein, George ;
Natale, Andrea ;
Packer, Douglas ;
Skanes, Allan ;
Ambrogi, Federico ;
Biganzoli, Elia .
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2010, 3 (01) :32-38
[4]   Single procedure efficacy of isolating all versus arrhythmogenic pulmonary veins on long-term control of atrial fibrillation: A prospective randomized study [J].
Dixit, Sanjay ;
Gerstenfed, Edward P. ;
Ratcliffe, Sarah J. ;
Cooper, Joshua M. ;
Russo, Andrea M. ;
Kimmel, Stephen E. ;
Callans, David J. ;
Lin, David ;
Verdino, Raph J. ;
Patel, Vickas V. ;
Zado, Erica ;
Marchlinski, Francis E. .
HEART RHYTHM, 2008, 5 (02) :174-181
[5]   Ablation for longstanding permanent atrial fibrillation: Results from a randomized study comparing three different strategies [J].
Elayi, Claude S. ;
Verma, Atul ;
Di Biase, Luigi ;
Ching, Chi Keong ;
Patel, Dimpi ;
Barrett, Conor ;
Martin, David ;
Rong, Bai ;
Fahmy, Tamer S. ;
Khaykin, Yaariv ;
Hongo, Richard ;
Hao, Steven ;
Pelargonio, Gemma ;
Dello Russo, Antonio ;
Casella, MicheLa ;
Santarelli, Pietro ;
Potenza, Domenico ;
Fanelli, Raffaete ;
Massaro, Raimondo ;
Arruda, Mauricio ;
Schweikert, Robert A. ;
Natale, Andrea .
HEART RHYTHM, 2008, 5 (12) :1658-1664
[6]   Catheter ablation of long-lasting persistent atrial fibrillation:: Clinical outcome and mechanisms of subsequent arrhythmias [J].
Haïssaguerre, MHR ;
Hocini, M ;
Sanders, P ;
Sacher, F ;
Rotter, M ;
Takahashi, Y ;
Rostock, T ;
Hsu, LF ;
Bordachar, P ;
Reuter, S ;
Roudaut, R ;
Clémenty, J ;
Jaïs, P .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2005, 16 (11) :1138-1147
[7]   A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate [J].
Nademanee, K ;
McKenzie, J ;
Kosar, E ;
Schwab, M ;
Sunsaneewitayakul, B ;
Vasavakul, T ;
Khunnawat, C ;
Ngarmukos, T .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (11) :2044-2053
[8]   Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation [J].
Oral, H ;
Knight, BP ;
Tada, H ;
Özaydin, M ;
Chugh, A ;
Hassan, S ;
Scharf, C ;
Lai, SWK ;
Greenstein, R ;
Pelosi, F ;
Strickberger, SA ;
Morady, F .
CIRCULATION, 2002, 105 (09) :1077-1081
[9]   Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms [J].
Oral, Hakan ;
Chugh, Aman ;
Good, Eric ;
Wimmer, Alan ;
Dey, Sujoya ;
Gadeela, Nitesh ;
Sankaran, Sundar ;
Crawford, Thomas ;
Sarrazin, Jean F. ;
Kuhne, Michael ;
Chalfoun, Nagib ;
Wells, Darryl ;
Frederick, Melissa ;
Fortino, Jackie ;
Benloucif-Moore, Suzanne ;
Jongnarangsin, Krit ;
Pelosi, Frank, Jr. ;
Bogun, Frank ;
Morady, Fred .
CIRCULATION, 2007, 115 (20) :2606-2612
[10]   Randomized Evaluation of Right Atrial Ablation After Left Atrial Ablation of Complex Fractionated Atrial Electrograms for Long-Lasting Persistent Atrial Fibrillation [J].
Oral, Hakan ;
Chugh, Aman ;
Good, Eric ;
Crawford, Thomas ;
Sarrazin, Jean F. ;
Kuhne, Michael ;
Chalfoun, Nagib ;
Wells, Darryl ;
Boonyapisit, Warangkna ;
Gadeela, Nitesh ;
Sankaran, Sundar ;
Kfahagi, Ayman ;
Jongnarangsin, Krit ;
Pelosi, Frank, Jr. ;
Bogun, Frank ;
Morady, Fred .
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2008, 1 (01) :6-13