Universität zu Köln

Vogler, Julia, Willems, Stephan, Sultan, Arian, Schreiber, Doreen, Lueker, Jakob, Servatius, Helge ORCID: 0000-0003-2887-8707, Schaeffer, Benjamin, Moser, Julia, Hoffmann, Boris A. and Steven, Daniel (2015). Pulmonary Vein Isolation Versus Defragmentation The CHASE-AF Clinical Trial. J. Am. Coll. Cardiol., 66 (24). S. 2743 - 2753. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1558-3597

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Abstract

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, arrhythmiafree 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]; (C) 2015 by the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Vogler, Julia UNSPECIFIED UNSPECIFIED UNSPECIFIED Willems, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Sultan, Arian UNSPECIFIED UNSPECIFIED UNSPECIFIED Schreiber, Doreen UNSPECIFIED UNSPECIFIED UNSPECIFIED Lueker, Jakob UNSPECIFIED UNSPECIFIED UNSPECIFIED Servatius, Helge UNSPECIFIED orcid.org/0000-0003-2887-8707 UNSPECIFIED Schaeffer, Benjamin UNSPECIFIED UNSPECIFIED UNSPECIFIED Moser, Julia UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Boris A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Steven, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-383550
DOI:	10.1016/j.jacc.2015.09.088
Journal or Publication Title:	J. Am. Coll. Cardiol.
Volume:	66
Number:	24
Page Range:	S. 2743 - 2753
Date:	2015
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1558-3597
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PERSISTENT ATRIAL-FIBRILLATION; GUIDED SUBSTRATE ABLATION; CATHETER ABLATION; FOLLOW-UP; TERMINATION; ELECTROGRAMS; PERMANENT; EFFICACY; OUTCOMES; SUCCESS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38355