Pulmonary antrum radial-linear ablation for paroxysmal atrial fibrillation: interim analysis of a multicenter trial.

BACKGROUND Substrate abnormality in pulmonary vein (PV) antrum plays a critical role in mechanism of atrial fibrillation (AF). The present study compares the strategy of PV antrum radial-linear (PAR) ablation to encircling PV isolation for paroxysmal AF. METHODS AND RESULTS A total of 86 patients with paroxysmal AF were randomly assigned to PAR ablation group or PV isolation group. The average procedure time was 161±21 minutes in PAR ablation group and 199±39 minutes in PV isolation group (P<0.01). The average fluoroscopy time was 25±5 minutes in PAR ablation group and 32±9 minutes in PV isolation group (P<0.001). At 14 (15-12) months of follow-up after single procedure, 31 of 42 (74%) patients in PAR ablation group and 22 of 44 patients (50%) in PV isolation group had no recurrence of AF off antiarrhythmic drug (P=0.0249); and 36 of 42 patients (86%) in PAR ablation group and 26 of 44 patients (59%) in PV isolation group had no recurrence of AF with antiarrhythmic drug (P=0.006). In addition, PAR ablation resulted in greater reduction of left atrial diameter than encircling PV isolation. Multivariable Cox regression analysis showed that only ablation strategy was independently associated with AF recurrence (hazard ratio, 0.31; 95% confidence interval, 0.12-0.78; P=0.013). No major adverse event related to the procedures occurred. CONCLUSIONS This study suggests that PAR ablation is a potentially effective strategy for treatment of paroxysmal AF warranting further investigation. CLINICAL TRIAL REGISTRATION URL: http://www.chictr.org; Unique identifier: ChiCTR-TRC-11001191.