Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(7), 785–793. https://doi.org/10.1002/clc.24038 Rajdip Dulai et al.
Points
- Atrial fibrillation patients often undergo atrioventricular node (AVN) catheter ablation, with retrograde left-sided (LSA) and anterograde right-sided (RSA) approaches compared in a randomized controlled trial.
- The study, involving 31 patients, found no significant differences in ablation time, procedure time, fluoroscopy time, radiation dose, or the number of radiofrequency (RF) applications between LSA and RSA groups.
- Adverse events, such as femoral hematomas requiring intervention, occurred in both LSA (6.67%) and RSA (6.25%) cohorts.
- Patient-reported discomfort was comparable between the two groups, with no significant variation noted.
- The study concluded that retrograde LSA does not offer notable advantages over conventional RSA in terms of AVN ablation, leading to the termination of the study before full recruitment due to futility.
Summary
In atrial fibrillation treatment, catheter ablation of the atrioventricular node (AVN) has long been an established method for alleviating symptomatic patients. This study, conducted through a randomized controlled trial, sought to scrutinize the efficacy and safety of retrograde left-sided ablation (LSA) in contrast to anterograde right-sided ablation (RSA). Thirty-one patients underwent AVN ablation, with 15 assigned to the LSA group and 16 to the RSA group, incorporating a crossover option after six unsuccessful radiofrequency (RF) applications.
The patient demographics revealed that LSA was associated with a mean age of 77.00 ± 5.17 years, while RSA corresponded to an average age of 79.44 ± 6.08 years. Notably, the two groups had no substantial difference in ablation time, with LSA and RSA exhibiting durations of 210.40 ± 179.77 and 192.19 ± 130.29 seconds, respectively. The study further indicated no significant distinctions in various procedural aspects, including procedure time, fluoroscopy time, radiation dose, or the number of RF applications between LSA and RSA. Nonetheless, adverse events were recorded in both cohorts, with femoral hematomas necessitating blood transfusions or interventions noted in 6.67% of LSA cases and 6.25% of RSA cases. Additionally, patient-reported discomfort did not exhibit marked differences between the LSA and RSA groups, with scores of 16.43 ± 20.67 and 17.87 ± 28.08, respectively.
In light of these findings, the study was terminated prematurely due to the lack of meaningful benefits, and it cannot recommend retrograde LSA as a primary clinical approach for AVN ablation.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24038
References Dulai, R., Sulke, N., Furniss, S. S., Malaweera, A., Lambiase, P. D., Patel, N., & Veasey, R. A. (2023). A randomized comparison of retrograde left‐sided versus anterograde right‐sided ablation of the atrioventricular junction. Clinical Cardiology, 46(7), 785–793. https://doi.org/10.1002/clc.24038
