Ablation strategy
|
PVI ± linear lesions, ablation of complex fractionated electrograms, or
combination ± Cardioversion
|
PVI + posterior wall isolation ± Cardioversion
|
PVI + linear lesions + left atrial complex fractionated electrograms ±
Cardioversion and cavotricuspid isthmus ablation
|
PVI with ablation of complex or fractionated electrograms ± linear
lesions ± Cavotricuspid isthmus ablation
|
PVI + posterior wall isolation ± SVC isolation ± linear lesions ± left
atrial complex fractionated electrograms ± Cardioversion
|
PVI ± Linear lesions ± ganglion plexus ± electrogram-based
approaches
|
PVI ± additional ablation lesions at the discretion of the
operators
|
PVI ± complex atrial fractionated electrograms ± roof line ±
mitral isthmus line ± left atrial posterior wall isolation
|
Frequency of monitoring (months) |
1, 3, 6, & 12 |
1.5, 3 & 6 |
3,6 & 12 |
1, 3 & 6 |
3, 6, 12 & 24 |
3, 6, & 12 months, then
every 6 months |
3, 6, 12, 24, 36, 48 & 60 |
2, 4, & 6 months, then
every 6 months |
Method of assessing rhythm on follow up |
12-lead ECG at
follow-up, patient-performed surface devices, & implantable devices |
Holter monitor at 3 and 6 months |
ECG at follow-up + 48h Holter monitor
at 6 and 12 months ± existing implantable devices |
12-lead ECG, 48h
Holter monitor |
ECG at 3 and 24 months, and existing implantable device
interrogation at 3, 6, 12, and 24 months |
CABANA monitoring system: ECG
event recorder, with 24-hour autodetect and 96-hour Holter monitoring
every 6 months |
Existing implantable device interrogation |
12-lead ECG
at each follow-up for all patients + 14-day ambulatory monitoring
(CardioSTAT) at 12- and 24-months in 7 centers |
Repeat ablation |
10 (15%) |
Allowed if symptomatic recurrence
>3 months after procedure |
5 (19.2%) |
14 (53.8%) |
1.4
± 0.6 procedures per person |
Repeat procedure was allowed |
37 (24.5%) |
77 (37.6%) |
Crossover |
3 |
3 |
2 |
None |
None |
None |
46 (28 to medical
therapy, 18 to ablation) |
None |
Loss to follow-up |
17 ablation, 13 medical therapy |
None |
None |
1 ablation, 1 medical therapy |
None |
N/A |
23 ablation, 10
medical therapy |
3 ablation, 4 medical therapy |
AAD on follow-up
|
Amiodarone in 23 patients (34%) in the ablation arm and 39 (54%) in
the control arm at 12 month follow-up
|
AAD resumed if present or started after early recurrence
|
AAD stopped post ablation unless indicated by other reasons
|
AAD stopped post ablation unless indicated by other reasons
|
AAD allowed during the blanking period (3 months)
|
AAD allowed during the blanking period (3 months)
|
48 patients (25%) in the ablation arm and 64 (35%) in the control
arm
|
AAD allowed 4-6 weeks post ablation and as adjunctive therapy after ≥ 2
ablation procedures. 48 patients (22.8%) of
the ablation group and 12 patients (6.2%) on AAD at last
follow-up.
|
PVI: Pulmonary vein isolation, AAD: Antiarrhythmic
drug, N/A: Not available |
PVI: Pulmonary vein
isolation, AAD: Antiarrhythmic drug, N/A: Not
available |
PVI: Pulmonary vein isolation, AAD:
Antiarrhythmic drug, N/A: Not available |
PVI:
Pulmonary vein isolation, AAD: Antiarrhythmic drug,
N/A: Not available |
PVI: Pulmonary vein isolation,
AAD: Antiarrhythmic drug, N/A: Not available |
PVI: Pulmonary vein isolation, AAD: Antiarrhythmic
drug, N/A: Not available |
PVI: Pulmonary vein
isolation, AAD: Antiarrhythmic drug, N/A: Not
available |
PVI: Pulmonary vein isolation, AAD:
Antiarrhythmic drug, N/A: Not available |
|