Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation

• Published in: Circulation (New York, N.Y.) Vol. 105; no. 9; pp. 1077 - 1081
• Main Authors: ORAL, Hakan, KNIGHT, Bradley P, STRICKBERGER, S. Adam, MORADY, Fred, TADA, Hiroshi, ÖZAYDIN, Mehmet, CHUGH, Aman, HASSAN, Sohail, SCHARF, Christoph, LAI, Steve W. K, GREENSTEIN, Radmira, JR, Frank Pelosi
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 05.03.2002; American Heart Association, Inc
• Subjects: Adult; Aged; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiology. Vascular system; Catheter Ablation - adverse effects; Catheter Ablation - methods; Coronary heart disease; Disease-Free Survival; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Membrane Potentials; Middle Aged; Multivariate Analysis; Postoperative Complications - etiology; Prospective Studies; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Recurrence; Reoperation; Retinal Artery Occlusion - etiology; Treatment Outcome; Vascular Patency; Human; Prognosis; Arrhythmia; Atrial fibrillation; Instrumentation therapy; Cardiovascular disease; Radiofrequency; Ablation; Excitability disorder; Treatment; Follow up study; Heart disease; Accessory bundle; Technique; Pulmonary vein
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/hc0902.104712

The pulmonary veins (PVs) have been demonstrated to often play an important role in generating atrial fibrillation (AF). The purpose of this study was to determine the safety and efficacy of segmental PV isolation in patients with paroxysmal or persistent AF. In 70 consecutive patients (mean age, 53 +/- 11 years) with paroxysmal (58) or persistent (12) AF, segmental PV isolation guided by ostial PV potentials was performed. The left superior, left inferior, and right superior PVs were targeted for isolation in all patients, and the right inferior PV was isolated in 20 patients. Among the 230 targeted PVs, 217 (94%) were completely isolated, with a mean of 6.5 +/- 4.2 minutes of radiofrequency energy applied at a maximum power setting of 35 W. A second PV isolation procedure was performed in 6 patients (9%). At 5 months of follow-up, 70% of patients with paroxysmal and 22% of patients with persistent AF were free from recurrent AF (P<0.001), and 83% of patients with paroxysmal AF were either free of symptomatic AF or had significant improvement. Among various clinical characteristics, only paroxysmal AF was an independent predictor of freedom from recurrence of AF (P<0.05). One patient developed unilateral quadrantopsia after the procedure. There were no other complications. With a segmental isolation approach that targets at least 3 PVs, a clinically satisfactory result can be achieved in >80% of patients with paroxysmal AF. The clinical efficacy of pulmonary vein isolation is much lower when AF is persistent than when it is paroxysmal.