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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
  1. Dhiraj Gupta (d.gupta{at}qmul.ac.uk)
  1. St. Bartholomew's Hospital, London, United Kingdom
    1. Mark J Earley
    1. St. Bartholomew's Hospital, London, United Kingdom
      1. Guy A Haywood
      1. Derriford Hospital, Plymouth, United Kingdom
        1. Laura Richmond
        1. St. Bartholomew's Hospital, London, United Kingdom
          1. Melissa Fitzgerald
          1. Derriford Hospital, Plymouth, United Kingdom
            1. Pipin Kojodjojo
            1. St. Mary's Hospital, London, United Kingdom
              1. Simon C Sporton
              1. St. Bartholomew's Hospital, London, United Kingdom
                1. Nicholos S Peters
                1. St. Mary's Hospital, London, United Kingdom
                  1. Paul Broadhurst
                  1. Aberdeen Royal Infirmary, United Kingdom
                    1. Richard J Schilling
                    1. St. Bartholomew's Hospital, London, United Kingdom

                      Abstract

                      Objective To see if a strategy of ablating the tricuspid annulus-inferior vena cava isthmus (TA-IVC) is superior to electrical cardioversion to prevent recurrences in patients with coarse atrial fibrillation (AF).

                      Design Prospective randomised controlled multi-centre study.

                      Setting 4 tertiary referral hospitals in the United Kingdom.

                      Patients 57 patients with persistent 'coarse AF' (irregular p waves ≥0.15mV in ≥1 ECG lead)

                      Interventions Patients were randomised to receive external cardioversion (Group A, n=30) or TA-IVC ablation +/- 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 post procedure.

                      Results 20 (67%) patients in Group A and 19 (70%) patients in Group B were in sinus rhythm (SR) immediately following their index procedure. At 4, 16 and 52 weeks, the number of patients in SR 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 though they were significantly better in SR as compared to AF at each follow up visit.

                      Conclusions As a first line strategy TA-IVC ablation offers no advantages over DCCV for the management of coarse AF.

                      • atrial fibrillation
                      • atrial flutter
                      • catheter ablation
                      • isthmus

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