Abstract 14368: Long Term Freedom From Atrial Fibrillation In Patients With Paroxysmal Atrial Fibrillation and Documented Pulmonary Vein Antrum Isolation.
Introduction: Long term freedom from atrial fibrillation (AF), in patients with paroxysmal AF (PAF) and proven isolation of the pulmonary vein is unknown.
Methods: Ninety eight (98) consecutive patients with PAF undergoing ablation were enrolled in this study. Patients underwent pulmonary vein antrum (PVA) isolation. In the period between 3 to 6 months post ablation, irrespective of recurrences, patients underwent a left atrial catheterization to exclude the presence of pulmonary vein reconnection. In case of reconnection, patients underwent re-isolation of the pulmonary veins and a third procedure was considered to confirm permanent isolation. Patients were followed-up after the last procedure showing isolation with event recordings and 7-day Holters. After documented PVA isolation, and in case of recurrence, an additional procedure was considered during which non-PV triggers were identified with the administration of high dose of isoproterenol.
Results: After a single procedure PVA remained isolated in 58% of the cases (57pts). The 41 patients (42%) with PV reconnection underwent re-isolation of the PVA. At the third procedure all PVs, except in 1 patient, remained isolated. At 46±6 months of follow-up the overall success rate was 74% off AADs. The success rate was 91 % at 6 months follow up, 87% at 1 year, 79% at two years, 76% at 3 years, and 74% at the last follow up. At the multivariate analysis, long episode of AF (more than 24 hours) [hazard ratio (HR) 1.70, 95% CI 1.34 to 2.16, p=0.002], left atrial size (>4.5cm) (HR 1.96, 95% CI 1.11 to 3.46, p= 0.02) and female sex (HR 3.26, 95% CI 1.05 to 5.26, p=0.04) were predictors of long term failure despite PVA isolation. Figure
Conclusions: In patients with PAF, permanent PVA isolation alone is associated with a good long term freedom from AF. Recurrence due to non PV triggers appeared clustered in the first 2 years. Whether non PVA triggers become relevant later in the patient life is unclear.
- © 2011 by American Heart Association, Inc.