Stratification and outcomes in patients with paroxysmal atrial fibrillation: pulmonary vein ablation versus linear lesions

Introduction and method Because of the heterogeneity of atrial fibrillation (AF), various ablative approaches have been proposed in order to identify an effective treatment for the arrhythmias. The aim of the present study was to report the long-term clinical outcome of patients undergoing two distinct ablative strategies: right linear lesions and pulmonary vein ablation. Based on mapping, group 1 (n = 58) included patients who underwent focal ablation or an attempt at pulmonary vein isolation, whereas group 2 (n = 40) included patients selected for right linear lesions. Results In group 1, over a mean follow up of 12 ± 2 months, 39 patients (67%) were in stable sinus rhythm, and 18 (46%) were off drug treatment. An additional 11 patients (19%) had sporadic AF episodes on drug therapy. An unchanged clinical scenario was reported in eight patients (14%). In group 2, at a mean follow up of 19 ± 4 months, 23 patients (57%) were in regular sinus rhythm and 12 patients (30%) were off drug treatment. Recurrences occurred in 17 patients (42%), but the number of symptomatic AF episodes decreased from 4 ± 2 per month to 0. 9 ± 0. 3 per month (⁠ \ (P\ <\ 0. 001\) ⁠). Conclusion Right linear ablation can improve the quality of life in patients with AF, but it offers a lower success rate in terms of long-term outcome in comparison with pulmonary vein ablation. The results support the concept that the atrial muscle extending into the pulmonary vein plays a critical role in the pathophysiology of AF.