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PHASED ARRAY PULMONARY VEIN ISOLATION VS RADIOFREQUENCY CATHETER ABLATION FOR ATRIAL FIBRILLATION: A NON-INFERIORITY SYSTEMATIC REVIEW AND META-ANALYSIS
Abstracts METHODS:
Sixty-six consecutive patients (mean age 6212 yrs) undergoing CTI ablation for atrial flutter were prospectively enrolled to CF-Blinded (n¼30) or CF-Guided (n¼36) groups. A ThermoCool SmartTouch catheter (power 25-35 W) was used in all. The procedural endpoint was bidirectional isthmus block following a 20-min waiting period. In the CFGuided group, CF target range was 10-25g whereas in the CF-Blinded group, the operator was blinded to CF data. Posthoc analyses of CF parameters were performed to evaluate the optimal CF. RESULTS: The procedural endpoint was achieved in all patients. No major complications were seen. Total radiofrequency (RF) energy delivery required to achieve bidirectional block was significantly lower in the CFGuided group compared to the CF-Blinded group (15.08.7 min vs 19.212.4 min, p¼0.01). Fluoroscopy duration was 8.66.2 min in the CF-Guided group vs 15.57.4 min in the CF-Blinded group (p¼0.02). Procedure duration was 8342 min in the CF-Guided group vs to 9437 min in the CF-Blinded group (p¼0.60). Posthoc analysis of all ablation procedures showed a significant correlation between CF and total RF delivery time (r¼-50; p¼0.0001). CONCLUSION: CTI ablation for atrial flutter using CF-Guided is associated with a significant reduction in RF delivery and fluoroscopy times. A significant correlation between CF and total RF delivery time was observed.
425 PHASED ARRAY PULMONARY VEIN ISOLATION VS RADIOFREQUENCY CATHETER ABLATION FOR ATRIAL FIBRILLATION: A NON-INFERIORITY SYSTEMATIC REVIEW AND META-ANALYSIS AG Carrizo, P Lamelas, N Pinilla Echeverri, P Gal, AG Elvan, CA Morillo Hamilton, Ontario BACKGROUND:
Pulmonary vein isolation using radiofrequency (RF) catheter ablation is the cornerstone for atrial fibrillation
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(AF) ablation. Newer RF energy delivery methods have become recently available. However, limited information is available regarding the non-inferiority efficacy and safety boundaries of duty-phased radiofrequency AF catheter ablation. OBJECTIVE: To conduct a meta-analysis of randomized clinical trials (RCTs) comparing the efficacy and safety of duty-cycled RF ablation using the circular multi-electrode catheter (MEA) to conventional RF catheter pulmonary vein isolation (cPVI) in patients with primarily paroxysmal/ persistant AF (PAF). METHODS: Two independent investigators searched MEDLINE, EMBASE, CENTRAL and clinicaltrials.gov databases for RCTs in patients with PAF that compared MEA vs cPVI (February 2015). The primary outcome was to determine whether MEA was non-inferior to cPVI, regarding Atrial tachyarrhythmia (AT) recurrence. We selected an absolute risk difference of 5% with a two sided 5% alpha error as threshold for non-inferiority. Procedural time, fluoroscopy time and potential technique-related adverse events (cardiac tamponade, vascular complications, pulmonary vein stenosis and stroke) were evaluated as well. Fixed effects were used unless there was significant heterogeneity (I2 > 50%). Cochrane tool for risk of bias was used for study quality assessment and GRADE for outcome specific quality across studies. RESULTS: Four RCTs were reviewed for an overall of 830 patients included of which, 709 (85.4%) had paroxysmal AF and 121(14.6%) persistent AF. The upper 95% confidence interval absolute risk limit of any AT recurrence in the MEA group was 3%, meeting criteria for non-inferiority (risk difference -3%; 95% CI -10% - 3%; relative risk 0.92; 95% CI 0.92 - 1.09; I2¼ 0%) Procedural time was significantly reduced during MEA procedures (weighted mean difference -54.3 minutes; 95% CI -83.7 - 25.3; p< 0.001; I2¼ 95%). Non-significant reductions in fluoroscopy time (weighted mean difference -6.42 minutes; 95% CI -13.8 - 0.96; p ¼ 0.09; I2¼ 95%) and adverse events (RR 0.47; 95% CI 0.21 1.08; p¼ 0.07; I2¼ 0%) were detected during MEA procedures. CONCLUSION: In patients with primarily PAF, duty cycled pulmonary vein isolation was non-inferior and appears to be superior to conventional RF ablation of PAF regarding freedom from AF. Multi-electrode ablation is associated with a favorable safety profile, and is comparable to cPVI. Further larger RCTs are needed to determine which technology is associated with the lowest recurrence and adverse event rate. 426 PREDICTORS OF ARRHYTHMIA RECURRENCE FOLLOWING PULMONARY VEIN ANTRUM ISOLATION P Alipour, Y Khaykin, M Pirbaglou, A Pantano, P Ritvo, P Brown, L Chun, S Olesovsky, A Verma Newmarket, Ontario
Sixty-six consecutive patients (mean age 6212 yrs) undergoing CTI ablation for atrial flutter were prospectively enrolled to CF-Blinded (n¼30) or CF-Guided (n¼36) groups. A ThermoCool SmartTouch catheter (power 25-35 W) was used in all. The procedural endpoint was bidirectional isthmus block following a 20-min waiting period. In the CFGuided group, CF target range was 10-25g whereas in the CF-Blinded group, the operator was blinded to CF data. Posthoc analyses of CF parameters were performed to evaluate the optimal CF. RESULTS: The procedural endpoint was achieved in all patients. No major complications were seen. Total radiofrequency (RF) energy delivery required to achieve bidirectional block was significantly lower in the CFGuided group compared to the CF-Blinded group (15.08.7 min vs 19.212.4 min, p¼0.01). Fluoroscopy duration was 8.66.2 min in the CF-Guided group vs 15.57.4 min in the CF-Blinded group (p¼0.02). Procedure duration was 8342 min in the CF-Guided group vs to 9437 min in the CF-Blinded group (p¼0.60). Posthoc analysis of all ablation procedures showed a significant correlation between CF and total RF delivery time (r¼-50; p¼0.0001). CONCLUSION: CTI ablation for atrial flutter using CF-Guided is associated with a significant reduction in RF delivery and fluoroscopy times. A significant correlation between CF and total RF delivery time was observed.
425 PHASED ARRAY PULMONARY VEIN ISOLATION VS RADIOFREQUENCY CATHETER ABLATION FOR ATRIAL FIBRILLATION: A NON-INFERIORITY SYSTEMATIC REVIEW AND META-ANALYSIS AG Carrizo, P Lamelas, N Pinilla Echeverri, P Gal, AG Elvan, CA Morillo Hamilton, Ontario BACKGROUND:
Pulmonary vein isolation using radiofrequency (RF) catheter ablation is the cornerstone for atrial fibrillation
S223
(AF) ablation. Newer RF energy delivery methods have become recently available. However, limited information is available regarding the non-inferiority efficacy and safety boundaries of duty-phased radiofrequency AF catheter ablation. OBJECTIVE: To conduct a meta-analysis of randomized clinical trials (RCTs) comparing the efficacy and safety of duty-cycled RF ablation using the circular multi-electrode catheter (MEA) to conventional RF catheter pulmonary vein isolation (cPVI) in patients with primarily paroxysmal/ persistant AF (PAF). METHODS: Two independent investigators searched MEDLINE, EMBASE, CENTRAL and clinicaltrials.gov databases for RCTs in patients with PAF that compared MEA vs cPVI (February 2015). The primary outcome was to determine whether MEA was non-inferior to cPVI, regarding Atrial tachyarrhythmia (AT) recurrence. We selected an absolute risk difference of 5% with a two sided 5% alpha error as threshold for non-inferiority. Procedural time, fluoroscopy time and potential technique-related adverse events (cardiac tamponade, vascular complications, pulmonary vein stenosis and stroke) were evaluated as well. Fixed effects were used unless there was significant heterogeneity (I2 > 50%). Cochrane tool for risk of bias was used for study quality assessment and GRADE for outcome specific quality across studies. RESULTS: Four RCTs were reviewed for an overall of 830 patients included of which, 709 (85.4%) had paroxysmal AF and 121(14.6%) persistent AF. The upper 95% confidence interval absolute risk limit of any AT recurrence in the MEA group was 3%, meeting criteria for non-inferiority (risk difference -3%; 95% CI -10% - 3%; relative risk 0.92; 95% CI 0.92 - 1.09; I2¼ 0%) Procedural time was significantly reduced during MEA procedures (weighted mean difference -54.3 minutes; 95% CI -83.7 - 25.3; p< 0.001; I2¼ 95%). Non-significant reductions in fluoroscopy time (weighted mean difference -6.42 minutes; 95% CI -13.8 - 0.96; p ¼ 0.09; I2¼ 95%) and adverse events (RR 0.47; 95% CI 0.21 1.08; p¼ 0.07; I2¼ 0%) were detected during MEA procedures. CONCLUSION: In patients with primarily PAF, duty cycled pulmonary vein isolation was non-inferior and appears to be superior to conventional RF ablation of PAF regarding freedom from AF. Multi-electrode ablation is associated with a favorable safety profile, and is comparable to cPVI. Further larger RCTs are needed to determine which technology is associated with the lowest recurrence and adverse event rate. 426 PREDICTORS OF ARRHYTHMIA RECURRENCE FOLLOWING PULMONARY VEIN ANTRUM ISOLATION P Alipour, Y Khaykin, M Pirbaglou, A Pantano, P Ritvo, P Brown, L Chun, S Olesovsky, A Verma Newmarket, Ontario