Unilateral versus Bilateral Groin Puncture for Atrial Fibrillation Ablation

Multi-Center Prospective Randomized Study

Hee Tae Yu, Dong Geum Shin, Jaemin Shim, Gi Byoung Nam, Won Woo Yoo, Ji Hyun Lee, Tae Hoon Kim, Jae Sun Uhm, Boyoung Joung, Moon Hyoung Lee, Young Hoon Kim, Hui Nam Pak

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)360-367
Number of pages8
JournalYonsei medical journal
Volume60
Issue number4
DOIs
Publication statusPublished - 2019 Apr 1

Fingerprint

Groin
Punctures
Atrial Fibrillation
Prospective Studies
Hemostasis
Pain
Catheter Ablation
Pulmonary Veins
Back Pain
Visual Analog Scale
Patient Satisfaction

Keywords

  • Atrial fibrillation
  • catheter ablation
  • groin
  • puncture

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Unilateral versus Bilateral Groin Puncture for Atrial Fibrillation Ablation : Multi-Center Prospective Randomized Study. / Yu, Hee Tae; Shin, Dong Geum; Shim, Jaemin; Nam, Gi Byoung; Yoo, Won Woo; Lee, Ji Hyun; Kim, Tae Hoon; Uhm, Jae Sun; Joung, Boyoung; Lee, Moon Hyoung; Kim, Young Hoon; Pak, Hui Nam.

In: Yonsei medical journal, Vol. 60, No. 4, 01.04.2019, p. 360-367.

Research output: Contribution to journalArticle

Yu, Hee Tae ; Shin, Dong Geum ; Shim, Jaemin ; Nam, Gi Byoung ; Yoo, Won Woo ; Lee, Ji Hyun ; Kim, Tae Hoon ; Uhm, Jae Sun ; Joung, Boyoung ; Lee, Moon Hyoung ; Kim, Young Hoon ; Pak, Hui Nam. / Unilateral versus Bilateral Groin Puncture for Atrial Fibrillation Ablation : Multi-Center Prospective Randomized Study. In: Yonsei medical journal. 2019 ; Vol. 60, No. 4. pp. 360-367.
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AU - Yu, Hee Tae

AU - Shin, Dong Geum

AU - Shim, Jaemin

AU - Nam, Gi Byoung

AU - Yoo, Won Woo

AU - Lee, Ji Hyun

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

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AU - Lee, Moon Hyoung

AU - Kim, Young Hoon

AU - Pak, Hui Nam

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AB - 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.

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