John M. Mandrola, MD; Felipe Atienza, MD, PhD


February 10, 2014

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A New Way of Treating Atrial Fibrillation

John M. Mandrola, MD: Hello. I am John Mandrola. I write the "Trials and Tribulations" column for Cardiology, and it's my pleasure to be with Dr. Felipe Atienza from the University of Madrid in Spain, who presented a late- breaking clinical trial today called RADAR-AF.[1] It's an exciting trial, and I am happy to welcome Dr. Atienza here to theh

Felipe Atienza, MD, PhD: Thank you.

Dr. Mandrola: Can you tell us about your trial?

Dr. Atienza: In our trial, we tested a new way of treating atrial fibrillation. In a way, most patients now are being treated empirically, and we aimed to target the mechanisms maintaining atrial fibrillation by targeting or ablating high-frequency sites.

Dr. Mandrola: That's exciting. What are these high- frequency sites all about?

Dr. Atienza: The high-frequency sites are the parts of the atria that are activating faster than the remainder of the atria, and those sites are detected by using computerized methods that enable seeing an analysis and localization of those sites.

Dr. Mandrola: Why are they important?

Dr. Atienza: When you heat them, you ablate them, and you are able to terminate atrial fibrillation in a substantial number of patients. Experimental studies have shown that those are the sites maintaining atrial fibrillation.

Dr. Mandrola: How did you set up the trial, with respect to randomization?

Dr. Atienza: We included all types of atrial fibrillation, both paroxysmal and persistent cases. We didn't include long-lasting persistent atrial fibrillation. We included 232 total patients. In patients with paroxysmal atrial fibrillation, the objective was to demonstrate the noninferiority of high-frequency source ablation (HFSA) to usual treatment, which is circumferential pulmonary vein isolation (CPVI). In contrast, in patients with persistent atrial fibrillation, the objective was to compare HFSA with a combination of CPVI and HFSA.

Dr. Mandrola: To be clear, among the patients with paroxysmal atrial fibrillation, one group had HFSA only. They did not get pulmonary vein isolation. It's likely that they received less ablation and focal ablation, correct?

Dr. Atienza: That's right.

Dr. Mandrola: What were the primary endpoints?

Dr. Atienza: The primary endpoint was freedom from atrial fibrillation at 6 months, and the secondary -- but not less important -- endpoints were freedom from atrial fibrillation and freedom from atrial cardiac arrhythmias at 6 and 12 months, together with complication rates (procedural and overall complication rates) and quality of life. Those were the endpoints of the study.


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