Adding Six Short Lines on Pulmonary Vein Isolation Circumferences Reduces Recurrence of Paroxysmal Atrial Fibrillation: Results from the Multicenter, Single-blind, Randomized Trial

Abstract Background Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) is associated with a non-negligible long-term recurrence rate. Objectives The aim of this study was to investigate whether PVI combined with six short ablation lines on the PVI circumferences (PVI+6L group) yields higher success rates than PVI alone (PVI group). Methods In this multicenter, single-blind, randomized trial, a total of 390 patients with paroxysmal AF were randomly assigned into PVI group (n=193) or PVI+6L group (n=197). The primary endpoint was freedom from AF/atrial tachycardia recurrence between 91 and 365 days. The secondary endpoints included AF burden, procedural parameters, and complications. Results Freedom from atrial tachyarrhythmia was achieved in in 160 of 197 patients (81.2%) in the PVI+6L group and 142 of 193 patients (73.6%) in the PVI group (hazard ratio, 0.61; 95% confidence interval, 0.39 to 0.97; P=0.040). Mean AF burden tended to be lower in PVI+6L group as compared to PVI group (1.95% vs. 0.53%, P=0.097). Procedure and ablation time were slightly longer in the PVI+6L group than in the PVI group (130 ± 25 vs. 121 ± 28 min, P=0.002, and 46 ± 14 vs. 41 ± 16 min, P=0.001, respectively) while X-ray exposure was similar (60 ± 54 vs. 61 ± 60 s, P=0.964). Complications occurred in three patients (1.6%) in the PVI group and in three patients (1.5%) in the PVI+6L group. Conclusions In patients with paroxysmal AF undergoing catheter ablation, adding six short ablation lines on the PVI circumferences could reduce recurrence rate of AF.