Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial
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Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial. / Vogler, Julia; Willems, Stephan; Sultan, Arian; Schreiber, Doreen; Lüker, Jakob; Servatius, Helge; Schäffer, Benjamin; Moser, Julia; Hoffmann, Boris A; Steven, Daniel.
In: J AM COLL CARDIOL, Vol. 66, No. 24, 22.12.2015, p. 2743-2752.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -