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Focal Ablation versus Single Vein Isolation for Atrial Tachycardia Originating from a Pulmonary Vein
Author(s) -
BARANOWSKI BRYAN,
WAZNI OUSSAMA,
LINDSAY BRUCE,
KANJ MOHAMMED,
SALIBA WALID,
BURKHARDT DAVID,
THOMAS GEORGE,
RICKARD JOHN,
TCHOU PATRICK
Publication year - 2010
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2010.02766.x
Subject(s) - medicine , pulmonary vein , ablation , atrial fibrillation , ostium , atrial tachycardia , cardiology , isolation (microbiology) , vein , tachycardia , catheter ablation , radiofrequency ablation , surgery , microbiology and biotechnology , biology
Background: Rapid, disorganized firing from a pulmonary vein (PV) focus may initiate atrial fibrillation. The natural history of PV atrial tachycardia (AT), resulting in a slower, more organized form of firing, is less clear. Furthermore, the optimal therapeutic approach to a PV AT is poorly defined.Objective: This study assessed the characteristics and long‐term outcomes of focal ablation versus PV isolation for ATs arising from a single PV.Methods: We reviewed 886 consecutive patients who underwent an AT radiofrequency ablation at our institution from January 1997 through August 2008.Results: Twenty‐six patients had focal AT with a mean cycle length of 364 ± 90 ms that arose from within a single PV. Ten patients underwent focal ablation of their AT and 16 patients underwent PV isolation of the culprit vein. All procedures were acutely successful. The average follow‐up was 25 months (range 2–90 months). There were three recurrences of AT in patients who underwent a focal ablation. There were no recurrences in patients who underwent targeted PV isolation (P = 0.046). No patients developed atrial fibrillation or AT from another focus during the follow‐up period.Conclusion: PV AT can be successfully treated with single vein isolation or focal ablation with a low risk of recurrence or the development of atrial fibrillation. PV isolation may be the preferred approach when the AT focus arises from a site distal to the ostium where targeted ablation could result in phrenic nerve injury or occlusion of a pulmonary venous branch. (PACE 2010; 776–783)