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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


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 +/− 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 19 (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.

  • DCCV, direct current cardioversion
  • INR, International Normalised Ratio
  • QOL, quality of life
  • TV–IVC, tricuspid valve–inferior vena cava isthmus

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