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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe ADVICE trial substudies show that the rate of pulmonary vein stenosis is low after pulmonary vein isolation with radiofrequency ablation and that the recommendations regarding the duration of the standard blanking period should be revised. The FreezeAF study demonstrates noninferiority of cryoballoon ablation to radiofrequency ablation.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EADVICE trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eblanking period\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecryoballoon ablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eearly recurrence\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFreezeAF trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epulmonary vein stenosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eradiofrequency ablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EAtrial fibrillation (AF) is the most commonly encountered clinical arrhythmia, and radiofrequency (RF) catheter ablation involving pulmonary vein isolation (PVI) has emerged as a standard procedure for the treatment of paroxysmal AF. However, this procedure remains technically challenging, with a substantial number of complications that have not been fully examined in large randomized trials.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESophie Gomes, MD, University of Montreal, Montreal, Quebec, Canada, presented results from a substudy of the ADVICE trial [Macle L et al. \u003Cem\u003ECan J Cardiol\u003C\/em\u003E. 2012], reporting the incidence and characteristics of pulmonary vein (PV) stenosis following catheter ablation of paroxysmal AF, while Boris A. Hoffmann, MD, University Hospital Hamburg-Eppendorf, Hamburg, Germany, presented results of another ADVICE trial substudy, reporting the incidence and significance of early recurrence of atrial tachyarrhythmias (ATs) after catheter ablation for paroxysmal AF. Also, Armin Luik, MD, Karlsruhe Municipal Hospital, Baden-W\u00fcrttemberg, Germany, presented results of the FreezeAF trial [Luik A. \u003Cem\u003EAm Heart J\u003C\/em\u003E. 2010], demonstrating that PVI with a cryoballoon (CB) is as effective as open irrigated RF PVI in patients with paroxysmal AF.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe data on incidence of PV stenosis associated with RF catheter ablation is limited to surveys and small trials, and the methods for determining PV stenosis assessment are not well defined. The analysis presented by Dr Gomes prospectively assessed the incidence and predictors of PV stenosis after RF catheter ablation of AF in the context of the large randomized multicenter ADVICE trial, which evaluated whether adenosine given during the initial PVI procedure may reveal dormant PV conduction, helping to identify the need for additional ablation and leading to improved outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the substudy, systematic imaging of the left atrium and PVs was performed at baseline and at 90 days postablation. PV stenosis was defined by a focal narrowing of PV diameter from the maximum adjacent diameter. Stenosis was classified as mild (\u0026lt;\u200550% narrowing), moderate (50%-70%), and severe (\u0026gt;\u200570%).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EA total of 197 patients were included in this substudy (mean age, 58.9 years; 71% men). PV imaging was performed at a mean of 103 days after PVI. Magnetic resonance imaging was used to assess 65.5% of patients, and a computed tomography scan was used in 34.5%. Severe PV stenosis was not detected in any patients. Moderate stenosis was observed in 5 patients (2.6%), and mild stenosis was identified in 42 patients (21.3%). None of the patients were symptomatic or required any intervention.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPredictive factors of PV stenosis determined in a multivariate analysis were left ventricular ejection fraction (OR, 0.93; 95% CI, 0.88 to 0.99; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0144) and diabetes mellitus (OR, 4.30; 95% CI, 1.22 to 15.12; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0229).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA significant correlation was observed between assessing PV stenosis using the percentage of reduction in PV diameter and the percentage of reduction in PV area.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe aim of the substudy presented by Prof Hoffmann was to investigate the clinical outcome in relation to prevalence and timing of early recurrence in the ADVICE trial. A \u201cblanking period\u201d of 3 months after ablation is generally supported by the current guidelines, although the clinical relevance of early recurrence is still debated. The primary end point of the substudy was therefore early recurrence, defined as symptomatic, documented AT \u2265\u200530 seconds within the first 3 months after ablation.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EA total of 179 patients experienced early recurrence. These patients had significantly lower freedom from late recurrence than those with no early recurrence (30.7% vs 77.2%, respectively; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001). Early recurrence persistence \u0026gt;2 months was associated with low long-term freedom from AF when compared with ER exclusively during the first month or the first 2 months (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). All comparisons were statistically significant (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/12\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Freedom From Symptomatic AT After a Single Ablation ProcedureAT, atrial tachyarrhythmia.Reproduced with permission from BA Hoffmann, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-737140745\u0022 data-figure-caption=\u0022Freedom From Symptomatic AT After a Single Ablation ProcedureAT, atrial tachyarrhythmia.Reproduced with permission from BA Hoffmann, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/12\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/12\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/12\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16715\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EFreedom From Symptomatic AT After a Single Ablation Procedure\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAT, atrial tachyarrhythmia.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EReproduced with permission from BA Hoffmann, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003EA receiver operating characteristic analysis demonstrated that a blanking period of 50 days would be best for determining long-term success rates following ablation for paroxysmal AF (sensitivity, 0.75; specificity, 0.83; accuracy, 0.78), suggesting that the current recommendations regarding the duration of the blanking period should be revised.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EThe FreezeAF trial, presented by Dr Luik, was a prospective randomized controlled noninferiority study with a combined primary end point defined as absence of AT \u0026gt;\u200530 seconds (after the standard 3-month blanking period) and absence of persistent complications at 6 and 12 months after the procedure. Secondary end points included periprocedural complications, total procedure duration, and total x-ray exposure. The main inclusion criteria were age of 18 to 75 years, 2 episodes of paroxysmal AF within the previous 3 months (\u2265\u20051 documented), and documented inefficacy of \u2265\u20051 antiarrhythmic drugs including a \u03b2-blocker.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EA total of 291 patients (CB group, 144; RF group, 147) completed the study. All baseline characteristics were well matched between the groups. Freedom from AF without persistent complications was achieved in 65% of patients in the CB group vs 64% in the RF group after a single PVI at 6 months (\u003Cem\u003EP\u003C\/em\u003E\u003Csub\u003ENoninferiority\u003C\/sub\u003E\u2005=\u2005.005) and in 74% in the CB group vs 72% in the RF group after multiple PVI procedures at 12 months (\u003Cem\u003EP\u003C\/em\u003E\u003Csub\u003ENoninferiority\u003C\/sub\u003E\u2005\u0026lt;\u2005.001), as demonstrated by the per-protocol analysis. The intention-to-treat analysis produced similar results.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EThe mean total procedure time was significantly longer for the RF group compared with the CB group, at 189.1 vs 167.4 minutes, respectively (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.006). However, the total x-ray dose was significantly higher for CB patients (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.012), as higher x-ray doses were needed to demonstrate balloon occlusions in this procedure.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EThe rate of complications was significantly higher in the CB group at 12.2% vs 5.0% in the RF group (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.021). The difference mainly resulted from a significantly higher rate of phrenic nerve palsy in the CB group compared with the RF group (5.8% vs 0%, respectively; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.002).\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EDr Luik concluded that PVI with CB is noninferior to open irrigated RF PVI in patients with paroxysmal AF.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/12\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlj21\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlj21\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}