Abstract 14387: Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation: a Decade of Follow-Up
Introduction: Pulmonary vein antrum isolation (PVAI) is the cornerstone of current catheter-based therapies for paroxysmal atrial fibrillation (AF). Data on very long-term follow-up of PVAI are limited. We report the outcome of PVAI in patients with paroxysmal AF over a decade of follow-up.
Methods: From 2000 to 2002 a total of 513 patients (age 54 ± 11 years, 73% males) with drug-refractory paroxysmal AF were referred to our Institutions for radiofrequency catheter ablation. PVAI extended to the posterior wall between the pulmonary veins was performed in all patients. Non-pulmonary vein triggers disclosed with high-dose isoproterenol challenge were targeted at the time of the repeat procedure(s). Follow-up was performed every 3 months for the first year, and every 6-9 months after the first year. The outcome of this study was freedom from recurrent AF/atrial tachycardia.
Results: At 10 years, single-procedure arrhythmia-free survival was achieved in 59% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5% between 6 and 10 years. Repeat procedure was offered to all patients with recurrent arrhythmia, and performed in 74% of these subjects (average 2 procedures/patient). Reconnection in the pulmonary vein antrum was found in 31% of patients after a single procedure, and in no patients after 2 procedures. Non-pulmonary vein triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 failed procedures. Predictors of very late recurrence due to non-pulmonary vein triggers included left atrial size, female sex, and obesity. At 10 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%.
Conclusions: In patients with paroxysmal AF undergoing with extended PVAI, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, a significant number of patients developed non-pulmonary vein triggers responsible for very late recurrent atrial arrhythmias.
- © 2013 by American Heart Association, Inc.