Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve—inferior vena cava isthmus? Results of a multicentre randomised controlled trial

Gupta, Dhiraj; Earley, Mark J.; Haywood, Guy A.; Richmond, Laura; Fitzgerald, Melissa; Kojodjojo, Pipin; Sporton, Simon C.; Peters, Nicholas S.; Broadhurst, Paul; Schilling, Richard J.
June 2007
Heart;Jun2007, Vol. 93 Issue 6, p688
Academic Journal
Objective: To see if strategy of ablating the tricuspid annulus-inferior vena cava isthmus (TV-IVC) is superior to electrical cardioversion to prevent recurrences in patients with coarse atrial fibrillation. Design: Prospective randomised controlled multicentre study. Setting: Four tertiary referral hospitals in the UK. Patients: 57 patients with persistent coarse atrial fibrillation (irregular P waves ⩾0. 15 mV in ⩾ 1 ECG lead). Interventions: Patients were randomised to receive external cardioversion (group A, n = 30) or TV-IVC ablation +1- DC cardioversion (group B, n = 27). Main outcome measures: Cardiac rhythm, scores on quality of life and symptom questionnaires were assessed at 4, 16 and 52 weeks after the procedure. Results: 20 (67%) patients in group A and 1 9 (70%) patients in group B were in sinus rhythm immediately after their index procedure. At 4, 16 and 52 weeks, the number of patients in sinus rhythm were 5, 3 and 2 in group A and 3, 3 and 1 in group B (p=NS). The quality of life and symptom questionnaire scores were similar in the two groups at each period of follow-up, although they were significantly better for sinus rhythm than for atrial fibrillation at each follow-up visit. Conclusions: As a first-line strategy, TV-IVC ablation offers no advantages over direct current cardioversion for the management of coarse atrial fibrillation.


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