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PRESSURE: Repeat electrophysiological study improves outcomes in paroxysmal AF

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SAN FRANCISCO — A strategy of early assessment with re-isolation of pulmonary vein reconnection may prevent atrial tachyarrhythmia recurrence, according to data presented at the Heart Rhythm Society Annual Scientific Sessions.

For the PRESSURE study, researchers randomly assigned 80 patients with drug-refractory paroxysmal atrial fibrillation after an initial pulmonary vein isolation procedure to standard care or a repeat electrophysiological study at 2 months regardless of symptoms. Patients were given an ECG recording device for 12 months and were instructed to self-record an ECG daily, as well as at time of symptoms. Atrial tachyarrhythmia 30 seconds or longer after the blanking period was considered a recurrence. Patients were given the Atrial Fibrillation Effect on Quality of Life questionnaire at baseline, 6 months and 12 months.

“Most of us would agree that pulmonary vein isolation is the cornerstone of AF ablation, but single-procedure success rates are low,” Dhiraj Gupta, MD, consultant cardiologist at the Liverpool Heart and Chest Hospital, United Kingdom, said during a presentation.

Dhiraj Gupta

According to results, of the 40 patients who had a repeat study, 25 (62.5%) had reconnection of 41 pulmonary veins. In the standard-care group, eight (20%) patients had to undergo a second pulmonary vein isolation. Compared with patients in the standard-care group, patients in the repeat study group had higher rates of freedom from atrial tachyarrhythmia (82.5% vs. 57.5%; P = .027). The repeat-study group also had higher quality-of-life scores at 6 months (88 vs. 63; P = .001) and 12 months (92.2 vs. 79.1; P = .03).

“For patients with paroxysmal AF undergoing pulmonary vein isolation, a strategy of repeat electrophysiological study and re-isolation of pulmonary vein reconnection at 2 months reduced atrial tachyarrhythmia and improved quality of life,” Gupta said. – by Tracey Romero

Reference:

Das M, et al. LBCT 02. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 4-7, 2016; San Francisco.

Disclosure: The study was funded by Biosense Webster. Gupta reports receiving speaking fees and funding from Biosense Webster.