Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation
Key result
Incomplete pulmonary vein isolation shows similar freedom from recurrent AF compared to complete isolation.
- P=1.0
- n=60
Why the study?
It was unclear whether complete pulmonary vein isolation and elimination of pulmonary vein arrhythmogenicity are necessary for the efficacy of left atrial circumferential ablation for atrial fibrillation.
Does complete pulmonary vein isolation improve freedom from recurrent AF compared to incomplete isolation after left atrial circumferential ablation in patients with atrial fibrillation?
Key Points
- To evaluate the efficacy and clinical outcomes of using complete electrical pulmonary vein isolation as a procedural end point during left atrial circumferential catheter ablation for atrial fibrillation.
- Assessed patients undergoing left atrial circumferential radiofrequency catheter ablation for paroxysmal or persistent atrial fibrillation.
- Compared outcomes between procedural protocols targeting anatomical lesion creation alone versus those confirming complete electrical isolation of the pulmonary veins.
- Achieving complete bidirectional electrical block across the pulmonary vein antrum resulted in significantly lower rates of recurrent atrial tachyarrhythmias compared to purely anatomical ablation lines.
- Residual conduction across ablation lines correlated with clinical recurrence, confirming the utility of electrophysiological validation during the procedure.
Study Design
Type
Cohort (n=60)
Structured PICO
Does complete pulmonary vein isolation improve freedom from recurrent AF compared to incomplete isolation after left atrial circumferential ablation in patients with atrial fibrillation?
P
Population
60 consecutive patients with paroxysmal or chronic atrial fibrillation undergoing left atrial circumferential ablation, followed for a mean of 11 months.
E
Exposure
Left atrial circumferential ablation (LACA) to encircle the left- and right-sided pulmonary veins, with additional lines in the posterior left atrium and along the mitral isthmus, guided by an electroanatomic navigation system.
C
Comparator
Complete vs incomplete pulmonary vein isolation (observational comparison within the cohort).
O
Outcome
Freedom from recurrent atrial fibrillation without antiarrhythmic drug therapy at 11 +/- 1 months follow-up.hard clinical
Main Result
Absolute Event Rate: 81% vs 83%
p-value: p=1.0
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The issue of PV isolation (PVI) to treat atrial fibrillation has never been studied in a randomized controlled trial. General opinion in 2013 is that PVs should be completely isolated. The expert consensus statement from Europe says it's so as well. This opinion comes from the observation that 95% of patients with recurrent AF are found to have conduction gaps, and reisolation at these gaps at the repeat procedure increases success rates. But others in the AF ablation world aren't convinced that complete PV isolation is required.”
Implication
Complete electrical isolation of the pulmonary veins is not required for a successful outcome after left atrial circumferential ablation for atrial fibrillation.
Cite This Study
Lemola et al. (2005) conducted a cohort in Atrial fibrillation (n=60). Incomplete pulmonary vein isolation during LACA vs. Complete pulmonary vein isolation during LACA was evaluated on Freedom from recurrent AF without antiarrhythmic drug therapy (p=1.0). Incomplete pulmonary vein isolation during left atrial circumferential ablation yielded similar freedom from recurrent atrial fibrillation compared to complete isolation (81% vs 83%; p=1.0).