HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.08.037v1 48/11/2340    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (33) Citing Articles via Google Scholar Google Scholar Articles by Pappone, C. Articles by Santinelli, V. Search for Related Content PubMed Articles by Pappone, C. Articles by Santinelli, V.

EXPEDITED REVIEW

A Randomized Trial of Circumferential Pulmonary Vein Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation

The APAF Study

Carlo Pappone, MD, PhD, FACC^_*,_*, Giuseppe Augello, MD^_*, Simone Sala, MD^_*, Filippo Gugliotta, BEng^_*, Gabriele Vicedomini, MD^_*, Simone Gulletta, MD^_*, Gabriele Paglino, MD^_*, Patrizio Mazzone, MD^_*, Nicoleta Sora, MD^_*, Isabelle Greiss, MD^_*, Andreina Santagostino, MD^_*, Laura LiVolsi, MD^_*, Nicola Pappone, MD, Andrea Radinovic, MD^_*, Francesco Manguso, MD, PhD^_* and Vincenzo Santinelli, MD^_*

^_* Division of Cardiac Pacing and Electrophysiology, San Raffaele University Hospital, Milan, Italy
Salvatore Maugeri Foundation, IRCCS, Telese Terme, Italy.

Manuscript received August 2, 2006; revised manuscript received August 23, 2006, accepted August 28, 2006.

^_* Reprint requests and correspondence: Dr. Carlo Pappone, Department of Arrhythmology, San Raffaele University Hospital, Via Olgettina 60, 20132—Milan, Italy. (Email: carlo.pappone{at}hsr.it).

OBJECTIVES: We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal atrial fibrillation (PAF).

BACKGROUND: Atrial fibrillation (AF) ablation strategy is superior to ADT in patients with an initial history of PAF, but its role in patients with a long history of AF as compared with ADT remains a challenge.

METHODS: One hundred ninety-eight patients (age, 56 ± 10 years) with PAF of 6 ± 5 years’ duration (mean AF episodes 3.4/month) who had failed ADT were randomized to AF ablation by circumferential pulmonary vein ablation (CPVA) or to the maximum tolerable doses of another ADT, which included flecainide, sotalol, and amiodarone. Crossover to CPVA was allowed after 3 months of ADT.

RESULTS: By Kaplan-Meier analysis, 86% of patients in the CPVA group and 22% of those in the ADT group who did not require a second ADT were free from recurrent atrial tachyarrhythmias (AT) (p < 0.001); a repeat ablation was performed in 9% of patients in the CPVA group for recurrent AF (6%) or atrial tachycardia (3%). At 1 year, 93% and 35% of the CPVA and ADT groups, respectively, were AT-free. Ejection fraction, hypertension, and age independently predicted AF recurrences in the ADT group. Circumferential pulmonary vein ablation was associated with fewer cardiovascular hospitalizations (p < 0.01). One transient ischemic attack and 1 pericardial effusion occurred in the CPVA group; side effects of ADT were observed in 23 patients.

CONCLUSIONS: Circumferential pulmonary vein ablation is more successful than ADT for prevention of PAF with few complications. Atrial fibrillation ablation warrants consideration in selected patients in whom ADT had already failed and maintenance of sinus rhythm is desired. (A Controlled Randomized Trial of CPVA Versus Antiarrhythmic Drug Therapy in for Paroxysmal AF: APAF/01; http://clinicaltrials.gov/ct/show; NCT00340314 [ClinicalTrials.gov] )

Abbreviations and Acronyms   AAD = antiarrhythmic drug   ADT = antiarrhythmic drug therapy   AF = atrial fibrillation   AT = atrial tachyarrhythmia   CPVA = circumferential pulmonary vein ablation   EF = ejection fraction   PAF = paroxysmal atrial fibrillation   SR = sinus rhythm

This article has been cited by other articles:

				S. A Lubitz, A. Fischer, and V. Fuster Catheter ablation for atrial fibrillation BMJ, April 12, 2008; 336(7648): 819 - 826. [Full Text] [PDF]

				D. Katritsis, M. A. Wood, E. Giazitzoglou, R. K. Shepard, G. Kourlaba, and K. A. Ellenbogen Long-term follow-up after radiofrequency catheter ablation for atrial fibrillation Europace, April 1, 2008; 10(4): 419 - 424. [Abstract] [Full Text] [PDF]

				A. Noheria, A. Kumar, J. V. Wylie Jr, and M. E. Josephson Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation: A Systematic Review Arch Intern Med, March 24, 2008; 168(6): 581 - 586. [Abstract] [Full Text] [PDF]

				W. Moreira, C. Timmermans, H. J.J. Wellens, Y. Mizusawa, S. Philippens, D. Perez, and L.-M. Rodriguez Can Common-Type Atrial Flutter Be a Sign of an Arrhythmogenic Substrate in Paroxysmal Atrial Fibrillation?: Clinical and Ablative Consequences in Patients With Coexistent Paroxysmal Atrial Fibrillation/Atrial Flutter Circulation, December 11, 2007; 116(24): 2786 - 2792. [Abstract] [Full Text] [PDF]

				C. Pappone and V. Santinelli Non-fluoroscopic mapping as a guide for atrial ablation: current status and expectations for the future Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I36 - I47. [Abstract] [Full Text] [PDF]

				P. Kirchhof, A. Auricchio, J. Bax, H. Crijns, J. Camm, H.-C. Diener, A. Goette, G. Hindricks, S. Hohnloser, L. Kappenberger, et al. Outcome parameters for trials in atrial fibrillation: executive summary: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA) Eur. Heart J., November 2, 2007; 28(22): 2803 - 2817. [Abstract] [Full Text] [PDF]

				P. Kirchhof, A. Auricchio, J. Bax, H. Crijns, J. Camm, H.-C. Diener, A. Goette, G. Hindricks, S. Hohnloser, L. Kappenberger, et al. Outcome parameters for trials in atrial fibrillation: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the European Heart Rhythm Association Europace, November 1, 2007; 9(11): 1006 - 1023. [Abstract] [Full Text] [PDF]

				M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre Catheter Ablation for Atrial Fibrillation Circulation, September 25, 2007; 116(13): 1515 - 1523. [Full Text] [PDF]

				P. Jais and D. L. Packer Ablation vs. drug use for atrial fibrillation Eur. Heart J. Suppl., September 1, 2007; 9(suppl_G): G26 - G34. [Abstract] [Full Text] [PDF]

				R. L. Frye Update in Cardiology Ann Intern Med, August 7, 2007; 147(3): 180 - 186. [Full Text] [PDF]

				H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]

				Pulmonary-Vein Ablation vs. Antiarrhythmic Drugs for Paroxysmal AFib Journal Watch Cardiology, January 3, 2007; 2007(103): 5 - 5. [Full Text]