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document
Atrial fibrillation catheter ablation versus surgical ablation treatment ( FAST ) : a 2-center randomized clinical trial . BACKGROUND Catheter ablation ( CA ) and minimally invasive surgical ablation ( SA ) have become accepted therapy for antiarrhythmic drug-refractory atrial fibrillation . This study describes the first randomized clinical trial comparing their efficacy and safety during a 12-month follow-up . METHODS AND RESULTS One hundred twenty-four patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension ( 42 patients , 33 % ) or failed prior CA ( 82 patients , 67 % ) were randomized to CA ( 63 patients ) or SA ( 61 patients ) . CA consisted of linear antral pulmonary vein isolation and optional additional lines . SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein , ganglionated plexi ablation , and left atrial appendage excision with optional additional lines . Follow-up at 6 and 12 months was performed by ECG and 7-day Holter recording . The primary end point , freedom from left atrial arrhythmia > 30 seconds without antiarrhythmic drugs after 12 months , was 36.5 % for CA and 65.6 % for SA ( P=0.0022 ) . There was no difference in effect for subgroups , which was consistent at both sites . The primary safety end point of significant adverse events during the 12-month follow-up was significantly higher for SA than for CA ( n=21 [ 34.4 % ] versus n=10 [ 15.9 % ] ; P=0.027 ) , driven mainly by procedural complications such as pneumothorax , major bleeding , and the need for pacemaker . In the CA group , 1 patient died at 1 month of subarachnoid hemorrhage . CONCLUSION In atrial fibrillation patients with dilated left atrium and hypertension or failed prior atrial fibrillation CA , SA is superior to CA in achieving freedom from left atrial arrhythmias after 12 months of follow-up , although the procedural adverse event rate is significantly higher for SA than for CA . CLINICAL TRIAL REGISTRATION URL : http : //clinicaltrials.gov . Unique identifier : NCT00662701 .
52801
Intervention_Surgical
Atrial fibrillation catheter ablation versus surgical ablation treatment ( FAST ) :
52802
Intervention_Surgical
Catheter ablation ( CA )
52803
Intervention_Surgical
minimally invasive surgical ablation ( SA )
52804
Intervention_Surgical
CA
52805
Intervention_Surgical
CA
52806
Intervention_Surgical
SA
52807
Intervention_Surgical
CA
52808
Intervention_Surgical
SA
52809
Intervention_Pharmacological
antiarrhythmic drugs
52810
Intervention_Surgical
CA
52811
Intervention_Surgical
SA
52812
Intervention_Surgical
SA
52813
Intervention_Surgical
CA
52814
Intervention_Surgical
CA
52815
Intervention_Surgical
CA
52816
Intervention_Surgical
SA
52817
Intervention_Surgical
CA
52818
Intervention_Surgical
SA
52819
Intervention_Surgical
CA
52820
Participant_Sample-size
One hundred twenty-four patients
52821
Participant_Condition
antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension
52822
Participant_Sample-size
( 42 patients
52823
Participant_Condition
failed prior CA
52824
Participant_Sample-size
82 patients
52825
Participant_Condition
atrial fibrillation
52826
Participant_Condition
dilated left atrium and hypertension
52827
Participant_Condition
failed prior atrial fibrillation CA