What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic drug-refractory paroxysmal atrial fibrillation (n=161). Intervention: Circumferential pulmonary vein isolation (CPVI). Primary outcome: Stable sinus rhythm after a single procedure.

February 1, 2018Circulation Arrhythmia and ElectrophysiologyOpen Access

Ten-Year Clinical Outcome After Circumferential Pulmonary Vein Isolation Utilizing the Hamburg Approach in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation

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Key result

Circumferential PVI for paroxysmal AF maintains 10-year stable sinus rhythm in ~33% after one procedure.

n=161

Why the study?

Does circumferential pulmonary vein isolation maintain long-term stable sinus rhythm in patients with symptomatic drug-refractory paroxysmal atrial fibrillation?

Key Points

The aim was to evaluate ten-year clinical outcomes after circumferential pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
161 patients with symptomatic drug-refractory paroxysmal atrial fibrillation underwent electroanatomical mapping-guided circumferential pulmonary vein isolation from 2003 to 2004.
The procedure involved placing circular lesions around pulmonary veins using irrigated radiofrequency energy with a double-lasso technique to confirm procedural success.
Follow-up included outpatient visits, Holter-ECGs, and telephonic interviews, with a median follow-up of 129 months.
Stable sinus rhythm was present in 53 of 161 (32.9%) patients after a single procedure.
After a mean of 1.73 procedures, stable sinus rhythm was achieved in 101 of 161 patients (62.7%).
Progression to persistent atrial fibrillation was seen in only 10 of 161 patients (6.2%).

Study Design

Type

Cohort (n=161)

Structured PICO

Does circumferential pulmonary vein isolation maintain long-term stable sinus rhythm in patients with symptomatic drug-refractory paroxysmal atrial fibrillation?

Population

161 patients with symptomatic drug-refractory paroxysmal atrial fibrillation, mean age 60±10 years.

Intervention

Circumferential pulmonary vein isolation (CPVI) guided by 3-dimensional electroanatomical mapping and double-lasso technique using irrigated radiofrequency energy.

Outcome

Stable sinus rhythm and progression of paroxysmal atrial fibrillation at long-term follow-up (>10 years).

At 10-year follow-up, CPVI for paroxysmal AF maintains stable sinus rhythm in 62.7% of patients after multiple procedures, with a low rate of progression to persistent AF.

Discussion

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Implication

Supports CPVI durability with repeat procedures in paroxysmal AF; leaves open single-procedure optimization pending randomized trials.

Cite This Study

Tilz et al. (2018) conducted a cohort in Symptomatic drug-refractory paroxysmal atrial fibrillation (n=161). Circumferential pulmonary vein isolation (CPVI) was evaluated on Stable sinus rhythm after a single procedure. Circumferential pulmonary vein isolation for paroxysmal atrial fibrillation resulted in stable sinus rhythm in 32.9% of patients after a single procedure and 62.7% after multiple procedures at 10 years.

synapsesocial.com/papers/6a0ea981a14f152feaf9ac8c https://doi.org/10.1161/circep.117.005250

Topics

Persistent AF management Atrial fibrillation AF ablation outcomes Anticoagulation in AF

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Ten-Year Clinical Outcome After Circumferential Pulmonary Vein Isolation Utilizing the Hamburg Approach in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Ten-Year Clinical Outcome After Circumferential Pulmonary Vein Isolation Utilizing the Hamburg Approach in Patients With Symptomatic Drug-Refractory Paroxysmal Atrial Fibrillation

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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