Abstract
Background: Use of intraprocedural observation and pharmacologic challenges have been proposed as means to differentiate permanent pulmonary vein (PV)–left atrial conduction block from inadequate ablation lesions. Objective: The purpose of this study was to determine the prevalence and clinical impact of spontaneous and adenosine-provoked reconnection using contemporary atrial fibrillation (AF) ablation technologies. Methods: The CIRCA-DOSE (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration) study enrolled 346 patients with paroxysmal AF and randomized them to contact force–guided radiofrequency ablation (CF-RF) or cryoballoon ablation. Patients underwent provocative testing with adenosine after a 20-minute observation period. All patients received an implantable cardiac monitor for arrhythmia monitoring. Results: Spontaneous reconnection was observed in 5.4% of PVs (71/1318) during the 20-minute postprocedure observation period, and dormant conduction was elicited in 5.7% of PVs (75/1318). Both spontaneous reconnection and dormant conduction were more common after CF-RF compared to cryoballoon ablation (P = .03 and P <.0001, respectively). Acute PV reconnection (spontaneous or adenosine-provoked) was associated with a significantly higher incidence of recurrent atrial tachyarrhythmia in the cryoballoon group (hazard ratio [HR] 2.39; 95% confidence interval [CI] 1.44–3.96; P = .0007) but not in the CF-RF group (HR 1.47; 95% CI 0.84–2.58; P = .16). In the absence of acute reconnection, the freedom from recurrent arrhythmia did not differ between groups (HR 0.95; 95% CI 0.6057–1.495; P = .83). Conclusion: Patients without spontaneous or adenosine-provoked reconnection had better outcomes compared to those with acute PV reconnection, suggesting that efforts should be directed toward ensuring an ideal ablation lesion at the first attempt in order to achieve durable PV isolation.
| Original language | English |
|---|---|
| Pages (from-to) | 897-904 |
| Number of pages | 8 |
| Journal | Heart Rhythm |
| Volume | 17 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2020 |
| Externally published | Yes |
Bibliographical note
Funding Information:The CIRCA-DOSE study was funded by a peer-reviewed grant from the Heart and Stroke Foundation of Canada (Grant Number G-13-0003121), with additional financial support from Medtronic and Heart Rhythm Services at the University of British Columbia. Drs Andrade and Deyell are supported by a Michael Smith Foundation for Health Research Scholar Award. Dr Khairy is supported by a research chair in electrophysiology and congenital heart disease. Dr Andrade reports grants and personal fees from Medtronic, grants from Baylis, and personal fees from Biosense Webster. Dr Verma reports grants and personal fees from Medtronic and Biosense Webster. Dr Deyell reports grants from Biosense Webster. Dr Leong-Sit reports personal fees from Medtronic and Biosense Webster. Dr Badra-Verdu eports personal fees from Medtronic. Dr Dubuc reports grants and personal fees from Medtronic. Dr Sapp reports grants and personal fees from Biosense Webster and St Jude Medical/Abbott and personal fees from Medtronic. Dr Macle reports personal fees from Medtronic and grants and personal fees from St Jude Medical/Abbott and Biosense Webster. Drs Champagne, Nattel, and Khairy have nothing to disclose. The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Clinicaltrials.gov Identifier: NCT01913522 (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration [CIRCA-DOSE]).
Publisher Copyright:
© 2020 Heart Rhythm Society
ASJC Scopus Subject Areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
PubMed: MeSH publication types
- Journal Article
- Multicenter Study
- Randomized Controlled Trial
- Research Support, Non-U.S. Gov't