@entity859 -guided XXXX for the treatment of @entity955 : an international, multicentre, randomised superiority trial.

@entity1 @entity64 @entity859 @entity358 @entity955 @entity4710 @entity943 @entity204
BACKGROUND: Catheter ablation is increasingly used to manage @entity955 , but @entity943 recurrences are common. @entity859 might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve @entity943 -free survival. We assessed whether @entity859 -guided @entity358 could prevent @entity943 recurrence in @entity1 undergoing radiofrequency catheter ablation for @entity955 . METHODS: We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled @entity1 aged older than 18 years who had had at least three symptomatic @entity955 episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After @entity358 , intravenous @entity859 was administered. If dormant conduction was present, @entity1 were randomly assigned (1:1) to additional @entity859 -guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected @entity1 were included in a registry. @entity1 were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. @entity1 were followed up for 1 year. The primary outcome was time to symptomatic @entity4710 after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980. FINDINGS: @entity859 unmasked dormant pulmonary vein conduction in 284 (53%) of 534 @entity1 . 102 (69  4%) of 147 @entity1 with additional @entity859 -guided ablation were free from symptomatic @entity4710 compared with 58 (42  3%) of 137 @entity1 with no further ablation, corresponding to an absolute risk reduction of 27  1% (95% CI 15  9-38  2; p<0  0001) and a hazard ratio of 0  44 (95% CI 0  31-0  64; p<0  0001). Of 115 @entity1 without dormant pulmonary vein conduction, 64 (55  7%) remained free from symptomatic @entity4710 (p=0  0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One @entity204 (massive @entity64 ) was deemed probably related to ablation in a @entity1 included in the registry. INTERPRETATION: @entity859 testing to identify and target dormant pulmonary vein conduction during catheter ablation of @entity955 is a safe and highly effective strategy to improve @entity943 -free survival in @entity1 with @entity955 . This approach should be considered for incorporation into routine clinical practice. FUNDING: Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).
