Circumferential ablation with pulmonary vein isolation achieved a long-term single-procedure success rate of 45%, which increased to 62% with repeat procedures.
Cohort (n=64)
Does circumferential ablation combined with pulmonary vein isolation improve long-term success in patients with atrial fibrillation?
Circumferential ablation with PV isolation for AF has a single-procedure success rate of approximately 45%, which improves to 62% with repeat procedures targeting recovered PV conduction.
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.
Cheema et al. (2006) conducted a cohort in Atrial fibrillation (n=64). Circumferential ablation with pulmonary vein isolation was evaluated on Long-term single-procedure success rate. Circumferential ablation with pulmonary vein isolation achieved a long-term single-procedure success rate of 45%, which increased to 62% with repeat procedures.