A Minimal or Maximal Ablation Strategy to Achieve Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation | Journal Scan

May 06, 2015
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Authors:
McLellan AJ, Ling LH, Azzopardi S, et al.
Citation:
A Minimal or Maximal Ablation Strategy to Achieve Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: A Prospective Multi-Centre Randomized Controlled Trial (the Minimax Study). Eur Heart J 2015;Apr 28:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does additional ablation along the intervenous ridge (IR) improve efficacy when added to circumferential antral pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF)?

Methods:

Two hundred thirty-four patients (mean age 59 years) with paroxysmal AF were randomly assigned to a minimal (circumferential antral PV isolation + IR ablation if needed) or maximal (circumferential antral PV isolation + routine ablation along the IR) ablation strategy. A 4-mm, irrigated-tip radiofrequency ablation catheter was used. Seven-day Holter monitoring was performed every 6 months.

Results:

PV isolation was achieved acutely in all patients. In the minimal group, 44% of patients required IR ablation for PV isolation. There was no significant difference in freedom from AF off antiarrhythmic drugs after a single procedure between the minimal (70%) and maximal (62%) ablation groups at a mean follow-up of 17 months. Within the minimal group, efficacy was higher when IR ablation was not necessary (80% vs. 62%). PV reconnection was found in 90% of 48 patients who had a redo procedure, with no difference between the two groups. Including redo procedures, freedom from AF was 80% in both groups. There was no PV stenosis in either group in 40 patients who underwent computed tomography 3 months post-procedure.

Conclusions:

The authors concluded that routine ablation along the IR does not improve efficacy when added to antral PV isolation.

Perspective:

The lower success rate in patients in the minimal group who required IR ablation to achieve PV isolation might be explained by the greater difficulty in achieving adequate contact force along the ridge compared to the antrum.

Keywords: Arrhythmias, Cardiac, Anti-Arrhythmia Agents, Atrial Fibrillation, Catheter Ablation, Constriction, Pathologic, Electrocardiography, Ambulatory, Follow-Up Studies, Pulmonary Circulation, Pulmonary Veins, Tomography, Vascular Diseases


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