Extensive pulmonary vein isolation-based catheter ablation maintained sinus rhythm without antiarrhythmic drugs in 83.6% of patients with paroxysmal or persistent AF at a mean of 27 months.
Cohort (n=574)
Does an extensive pulmonary vein isolation-based catheter ablation strategy maintain long-term sinus rhythm in patients with drug-refractory paroxysmal or persistent atrial fibrillation?
Extensive pulmonary vein isolation-based catheter ablation is highly effective for long-term maintenance of sinus rhythm in drug-refractory AF, with very late recurrences primarily driven by non-PV triggers.
OBJECTIVE: To examine the long-term clinical outcomes of patients undergoing catheter ablation (CA) for either paroxysmal (PAF) or persistent atrial fibrillation (PsAF) using an extensive pulmonary vein isolation (EPVI)-based strategy. METHODS AND RESULTS: 574 patients (61 ± 9 years; 449 men) with drug-refractory PAF or PsAF underwent CA. Ipsilateral pulmonary veins (PVs) were isolated with extensive antral ablation. A cavotricuspid isthmus line with bidirectional conduction block was created and all non-PV triggers of AF ablated at the index procedure. Left atrial linear ablation was performed in patients with PsAF if AF remained inducible. Patients with recurrent atrial arrhythmias had previous lesions assessed and consolidated. With mean follow up of 27 ± 14 months after the final procedure, 480 patients (83.6%) were in sinus rhythm without antiarrhythmic drugs (1.4 ± 0.6 procedures). The single procedure success rate without antiarrhythmic drugs was 65.5%. A late recurrence (>6 months after the initial procedure) and very late recurrence (>12 months) were seen in 1.6% and 1.7% of patients, respectively. All patients with a late recurrence had PV reconnection, with one patient also demonstrating a non-PV trigger. In comparison, non-PV triggers of AF accounted for 85.7% of very late recurrences with no evidence of PV reconduction. CONCLUSIONS: EPVI-based CA is effective in maintaining sinus rhythm in patients with PAF and PsAF over the long term. Recurrent AF after 1 year is mainly due to non-PV triggers, suggestive of an ongoing pathological process.
Miyazaki et al. (2010) conducted a cohort in paroxysmal and persistent atrial fibrillation (n=574). Extensive pulmonary vein isolation (EPVI)-based catheter ablation was evaluated on Sinus rhythm without antiarrhythmic drugs. Extensive pulmonary vein isolation-based catheter ablation maintained sinus rhythm without antiarrhythmic drugs in 83.6% of patients with paroxysmal or persistent AF at a mean of 27 months.