| 문희선¹ , 김종윤¹, 위진², 황혜진², 심재민², 엄재선², 정보영², 이문형², 박희남² |
Background: Circumferential pulmonary vein isolation(CPVI) has been considered as the cornerstone for radiofrequency catheter ablation(RFCA) of atrial fibrillation(AF). However, it is unclear whether linear ablation in addition to CPVI improves clinical outcome.
Methods: This study enrolled 156 patients(male 76.3%, 55.8±11.5 years old) who underwent RFCA for paroxysmal AF(PAF) as a prospective randomized study. We compared CPVI(n=52), CPVI+Roof line(CPVI+RL; n=52), and CPVI+RL+posterior inferior line(CPVI+PostBox; n=52).
Results: 1. CPVI group showed shorter total procedure time(180.4±39.5 min vs. 189.6±29.0 min, 201.7±51.7 min, respectively; p=0.035) and ablation time(4085.5±1384.1 sec vs. 5253.5±1010.9 sec, 5495.0±1316.0 sec, respectively; p<0.001) than CPVI+RL and CPVI+PostBox groups. 2. During 15.6±5.0 month follow-up, the recurrence rates three months after RFCA were 11.5% in CPVI, 21.2% in CPVI+RL, and 19.2% in CPVI+PostBox(p=0.440). 3. The achievement rate of bidirectional block was 100.0% in CPVI, 80.8% in CPVI+RL, and 59.6% in CPVI+PostBox. The clinical recurrence rates with or without achieving bidirectional block were not significantly different(p=0.412).
Conclusion: In patients with PAF, linear ablations in addition to CPVI did not improve clinical outcome, regardless of bidirectional block achievement, while it prolonged the total procedure and ablation time.
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