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Pulmonary Vein Re-Isolation as a Routine Strategy Regardless of Symptoms. The PRESSURE Randomized Controlled Trial

Lookup NU author(s): Dr Moloy Das


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© 2017 American College of Cardiology Foundation. Objectives: The goal of this study was to determine whether a strategy of early re-isolation of PV reconnection in all patients, regardless of symptoms, would reduce the recurrence of atrial fibrillation (AF) and improve quality of life. Background: Lasting pulmonary vein isolation (PVI) remains elusive. Pulmonary vein (PV) reconnection is strongly linked to the recurrence of arrhythmia. Methods: A total of 80 patients with paroxysmal AF were randomized 1:1 after contact force-guided PVI to receive either standard care or undergo a repeat electrophysiology study after 2 months regardless of symptoms (repeat study). At the initial procedure, PVI was demonstrated by entrance/exit block and adenosine administration after a minimum 20-min wait. At the repeat study, all sites of PV reconnection were re-ablated. Patients recorded electrocardiograms daily and whenever symptomatic for 12 months using a handheld monitor. Recurrence was defined as ≥30 s of atrial tachyarrhythmia (AT) after a 3-month blanking period. The Atrial Fibrillation Effect on Quality-of-Life Questionnaire was completed at baseline and at 6 and 12 months. Results: All 40 patients randomized to repeat study attended for this after 62 ± 6 days, of whom 25 (62.5%) had reconnection of 41 (26%) PVs. There were no complications related to these procedures. Subjects recorded a total of 32,203 electrocardiograms (380 [335 - 447] per patient) during 12.6 (12.2 - 13.2) months of follow-up. AT recurrence was significantly lower for the repeat study group (17.5% vs. 42.5%; p = 0.03), as was AT burden (p = 0.03). Scores on the Atrial Fibrillation Effect on Quality-of-Life Questionnaire were higher in the repeat study group at 6 months (p < 0.001) and 12 months (p = 0.02). Conclusions: A strategy of routine repeat assessment with re-isolation of PV reconnection improved freedom from AT recurrence, AT burden, and quality of life compared with current standard care. (The Effect of Early Repeat Atrial Fibrillation [AF] on AF Recurrence [PRESSURE]; NCT01942408).

Publication metadata

Author(s): Das M, Wynn GJ, Saeed Y, Gomes S, Morgan M, Ronayne C, Bonnett LJ, Waktare JEP, Todd DM, Hall MCS, Snowdon RL, Modi S, Gupta D

Publication type: Article

Publication status: Published

Journal: JACC: Clinical Electrophysiology

Year: 2017

Volume: 3

Issue: 6

Pages: 602-611

Print publication date: 01/06/2017

Online publication date: 29/03/2017

Acceptance date: 19/01/2017

ISSN (print): 2405-500X

ISSN (electronic): 2405-5018

Publisher: Elsevier Inc


DOI: 10.1016/j.jacep.2017.01.016


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