Long-Term Safety and Efficacy of Circumferential Ablation with Pulmonary Vein Isolation

Authors: CHEEMA, AAMIR; DONG, JUN; DALAL, DARSHAN; VASAMREDDY, CHANDRASEKHAR R.; MARINE, JOSEPH E.; HENRIKSON, CHARLES A.; SPRAGG, DAVID; CHENG, ALAN; NAZARIAN, SAMAN; SINHA, SUNIL; HALPERIN, HENRY; BERGER, RONALD; CALKINS, HUGH

Source: Journal of Cardiovascular Electrophysiology, Volume 17, Number 10, October 2006 , pp. 1080-1085(6)

Publisher: Wiley-Blackwell

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Abstract:

Circumferential Ablation with PV Isolation.

Background: Each of the two main approaches to catheter ablation of atrial fibrillation (AF, segmental and circumferential) is associated with moderate long-term efficacy.

Objective: To report the long-term outcomes of a modified technique that combines circumferential ablation with pulmonary vein (PV) isolation, determined by a circular mapping catheter and to determine the relationship between complete PV isolation and long-term efficacy.

Methods: The patient population was composed of 64 consecutive patients (47 men [73%]; age 59 ± 11 years) with AF who underwent catheter ablation. AF was paroxysmal in 29 (45%) and nonparoxysmal in 35 (55%). Each patient was followed for a minimum of 12 months.

Results: After a mean follow-up of 13 ± 1 months, the long-term single-procedure success rate was 45% (n = 29) with an additional 4% (n = 3) of patients demonstrating improvement. With repeat procedures in 19 patients, the overall long-term success rate was 62% (n = 40) with 9% (n = 6) demonstrating improvement. All the patients who underwent repeat ablations had recovered PV conduction. Incomplete PV isolation was the only independent predictor of failure. A major complication occurred in four (6%) patients, including three patients with vascular complications and one with cardiac tamponade.

Conclusion: Our results suggest that the long-term single-procedure efficacy of circumferential ablation with PV isolation in a cohort of patients with predominantly nonparoxysmal AF approaches 50%. Repeat procedures involving re-isolation of the PVs result in a significant improvement in outcomes. Complete electrical isolation of the PVs has a significant impact on the long-term efficacy of the procedure.

(J Cardiovasc Electrophysiol, Vol. 17, pp. 1080-1085, October 2006)

Keywords: atrial fibrillation; catheter ablation; pulmonary vein

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1540-8167.2006.00569.x

Affiliations: 1: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Publication date: 2006-10-01

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