Yonsei Med J.  2019 Apr;60(4):360-367. 10.3349/ymj.2019.60.4.360.

Unilateral versus Bilateral Groin Puncture for Atrial Fibrillation Ablation: Multi-Center Prospective Randomized Study

Affiliations
  • 1Department of Cardiology, Yonsei University Health System, Seoul, Korea. hnpak@yuhs.ac
  • 2Department of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
  • 3Department of Cardiology, Korea University Cardiovascular Center, Seoul, Korea.
  • 4Department of Cardiology, Asan Medical Center, Ulsan University, Seoul, Korea.

Abstract

PURPOSE
Catheter ablation for atrial fibrillation (AF) requires heavy anticoagulation and uncomfortable post-procedural hemostasis. We compared patient satisfaction with and the safety of unilateral groin (UG) puncture-single trans-septal (ST) ablation with conventional bilateral groin (BG) puncture-double trans-septal (DT) ablation in paroxysmal AF patients.
MATERIALS AND METHODS
We enrolled 222 patients with paroxysmal AF (59.4±10.7 years old) who were randomized in a 2:1 manner into UG-ST ablation (n=148) and BG-DT ablation (n=74) groups. If circumferential pulmonary vein isolation could not be achieved after three attempts of touch-up ablation in the UG-ST group, the patient was crossed over to BG-DT by performing a left groin puncture.
RESULTS
Ten patients in the UG-ST group (6.8%) required crossover to the BG-DT approach. There were no significant differences in procedure time (p=0.144) and major complications rate (p>0.999) between the UG-ST and BG-DT groups. Access site pain (p=0.014), back pain (p=0.023), and total pain (p=0.015) scores were significantly lower for the UG-ST than BG-DT group as assessed by the Visual Analog Scale. Over 20.2±8.7 months of follow up, there was no difference in AF recurrence free-survival rates between the two groups (Log rank, p=0.984).
CONCLUSION
UG-ST AF ablation is feasible and safe, and was found to significantly reduce post-procedural hemostasis-related discomfort, compared to the conventional DT approach, in patients with paroxysmal AF.

Keyword

Atrial fibrillation; catheter ablation; groin; puncture

MeSH Terms

Atrial Fibrillation*
Back Pain
Catheter Ablation
Follow-Up Studies
Groin*
Hemostasis
Humans
Patient Satisfaction
Prospective Studies*
Pulmonary Veins
Punctures*
Recurrence
Visual Analog Scale

Figure

  • Fig. 1 Flow diagram of study population enrollment. UG-ST, unilateral groin puncture-single trans-septal; BG-DT, bilateral groin puncture-double trans-septal.

  • Fig. 2 Representative images of conventional bilateral groin puncture-double trans-septal ablation (BG-DT) (A) and unilateral groin puncture-single trans-septal ablation (UG-ST) (B) strategies. If there was a remnant PV potential after anatomical and local potential guided CPVI in the UG-ST group, we mapped and marked the potential PV conduction site on a three-dimensional electroanatomical map and added tough-up ablation after an additional exchange of ablation and mapping catheters (C). CPVI, circumferential pulmonary vein isolation; PV, pulmonary vein; RA, right atrium; RV, right ventricle; CS, coronary sinus; LAO, left anterior oblique.

  • Fig. 3 Comparison of questionnaire results for post-procedural discomfort during hemostasis between the two groups. (A) Each component of quality of life was measured using a 0–10 VAS. (B) Total score of VAS results. UG-ST, unilateral groin puncture-single trans-septal; BG-DT, bilateral groin puncture-double trans-septal; VAS, visual analog scale.

  • Fig. 4 Kaplan-Meier analysis of AF recurrence-free survival (A) and AF recurrence-free survival off-AAD (B) after catheter ablation between the two groups. AF, atrial fibrillation; AAD, anti-arrhythmic drug; UG-ST, unilateral groin puncture-single trans-septal; BG-DT, bilateral groin puncture-double trans-septal.


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