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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 SMAN-PAF trial reveals that linear ablation in addition to pulmonary vein isolation does not decrease the rate of atrial fibrillation recurrence, while the HeartLight study demonstrates noninferiority of efficacy and safety with pulmonary vein isolation using visually guided laser balloon catheter when compared with irrigated radiofrequency ablation.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeartLight\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epulmonary vein isolation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPVI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eradiofrequency ablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERFA\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESMAN-PAF\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVGLB\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evisually guided laser balloon\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Earrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eimaging modalities\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\u003EGareth Wynn, MBChB, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom, presented results of the SMAN-PAF trial, demonstrating that treatment with linear ablation in addition to pulmonary vein isolation (PVI) did not decrease the rate of atrial fibrillation (AF) recurrence or improve the quality of life when compared with PVI alone.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EExtensive ablation that goes beyond PVI may be beneficial in patients with substrate-based AF. Wide area circumferential ablation (WACA) may alter substrates, creating barriers to reentry, interrupting rotor activation, and modifying autonomic innervation. However, the evidence supporting extensive ablation is limited and based on nonrandomized studies.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESMAN-PAF is a randomized controlled trial of PVI with WACA or PVI with WACA plus biatrial linear lesion set (PVI plus lines). All patients followed a universal antiarrhythmic drug (AAD) regimen for at least 6 weeks prior to and exactly 6 weeks after the procedure. The average follow-up was 12 months, with a standard 3-month blanking period. Patients and electrocardiogram assessors were both blinded to treatment.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary outcome measure was recurrence of atrial tachyarrhythmia \u0026gt;\u200530 seconds. Secondary outcomes included adverse events (AEs), effect on quality of life, procedural duration, and radiation exposure.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EA total of 130 patients (mean age, 61.9 years; 68% men) were enrolled and randomized to PVI (n\u2005=\u200564) or PVI plus lines (n\u2005=\u200566). Successful PVI was achieved in 98% of patients across both treatment groups, with bidirectional block achieved in 81% of patients treated with PVI plus lines.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ERecurrence of atrial tachyarrhythmia occurred in 32% of patients in the PVI group vs 38% in the PVI plus lines group within 12 months of a single procedure (RR, 0.87; 95% CI, 0.57 to 1.27; \u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.50).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProcedure duration and radiation exposure were significantly higher in patients treated with PVI plus lines as compared with those receiving PVI alone. The rate of major procedural complications and other AEs was low and occurred at a similar rate between the groups. The quality of life was evaluated by 2 questionnaires and increased significantly in both groups; however, the difference between treatment groups was not significant.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EDr Wynn concluded that treatment with linear ablation in addition to PVI did not improve the rate of AF recurrence or the quality of life, while the additional treatment increased procedure duration and radiation exposure.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EVivek Y. Reddy, MD, Mount Sinai Hospital, New York, New York, USA, presented results of the HeartLight study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01456000\u0026amp;atom=%2Fspmdc%2F15%2F12%2F6.atom\u0022\u003ENCT01456000\u003C\/a\u003E], demonstrating noninferiority of PVI with a visually guided laser balloon (VGLB) catheter compared with irrigated radiofrequency ablation (RFA), despite a significant difference in operator experience with these 2 technologies favoring the RFA group.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ETechnical difficulties with achieving PVI in patients with paroxysmal AF led to the development of novel catheter designs to facilitate the procedure [Dukkipati SR. \u003Cem\u003ECirc Arrhythm Electrophysiol\u003C\/em\u003E. 2013]. A visually guided laser ablation catheter was designed to allow the operator to visualize target tissue directly for ablation, and single-center trials have demonstrated favorable safety and efficacy of this device.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EHeartLight is a prospective randomized multicenter trial to determine the multicenter efficacy and safety of performing PVI with the VGLB catheter. The HeartLight system is an investigational device in the United States that has not yet been approved by the FDA.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThe primary efficacy and safety outcomes were assessed by noninferiority analyses and were defined as freedom from symptomatic AF for 1 year while off AAD and the rate of primary AEs, respectively.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EA total of 334 patients were evaluated in the trial (aged approximately 60 years; 66% men; n\u2005=\u2005167 in each treatment arm). The baseline characteristics were well matched between the groups.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EFreedom from AF for 1 year was achieved in 61.1% of patients in the VGLB group vs 61.7% in the RFA group in the per-protocol analysis, meeting the criteria for noninferiority (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.003). Similar results were seen when patients who could not stay off AAD were included in the analysis, with 65.3% of patients in the VGLB group vs 62.9% in the RFA group being free from AF for 1 year. The rate of patients who experienced primary AEs was 11.8% in the VGLB group vs 14.5% in the RFA group, meeting the end point of noninferiority (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.002).\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EPVI was achieved on the first mapping attempt in 89.8% in the VGLB group vs 84.0% in the RFA group (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.02). Pulmonary veins were reconnected after initial isolation in 2.7% and 5.7%, respectively (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.006). A post hoc analysis revealed that operator experience did not play a significant role in the safety or efficacy of the VGLB PVI procedure.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EDr Reddy concluded that PVI could be achieved in virtually all patients using a single VGLB catheter with similar efficacy and safety to RFA.\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\/6.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_openurl.js?nzlj5d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}