Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial

TY - JOUR

T1 - Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial

AU - Vogler, Julia

AU - Willems, Stephan

AU - Sultan, Arian

AU - Schreiber, Doreen

AU - Lüker, Jakob

AU - Servatius, Helge

AU - Schäffer, Benjamin

AU - Moser, Julia

AU - Hoffmann, Boris A

AU - Steven, Daniel

N1 - Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2015/12/22

Y1 - 2015/12/22

N2 - 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).

AB - 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).

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Atrial Fibrillation/physiopathology

KW - Catheter Ablation/methods

KW - Electrophysiologic Techniques, Cardiac/methods

KW - Female

KW - Follow-Up Studies

KW - Heart Conduction System/physiopathology

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Pulmonary Veins/surgery

KW - Recurrence

KW - Time Factors

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1016/j.jacc.2015.09.088

DO - 10.1016/j.jacc.2015.09.088

M3 - SCORING: Journal article

C2 - 26700836

VL - 66

SP - 2743

EP - 2752

JO - J AM COLL CARDIOL

JF - J AM COLL CARDIOL

SN - 0735-1097

IS - 24

ER -