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Is Empirical Four Pulmonary Vein Isolation Necessary for Focally Triggered Paroxysmal Atrial Fibrillation? Comparison of Selective Pulmonary Vein Isolation Versus Empirical Four Pulmonary Vein Isolation
Author(s) -
PAK HUINAM,
KIM JIN SEOK,
SHIN SEUNG YONG,
LEE HYUN SOO,
CHOI JONG IL,
LIM HONG EUY,
HWANG CHUN,
KIM YOUNGHOON
Publication year - 2008
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2007.01074.x
Subject(s) - medicine , pulmonary vein , atrial fibrillation , ablation , cardiology , paroxysmal atrial fibrillation , catheter ablation , vein , anesthesia , surgery
Background:We questioned whether the empirical four pulmonary vein (PV) isolation (EmPVI) was necessary in patients with paroxysmal atrial fibrillation (PAF) triggered from clearly and reproducibly defined arrhythmogenic PVs.Methods:We compared the selective or ipsilateral isolation of the PVs triggering AF (SePVI: n = 42) and EmPVI (n = 35) in 77 patients (males 80.5%, mean age 53.0 ± 13.4 years) with PAF who underwent radiofrequency catheter ablation (RFCA). Arrhythmogenic PVs were identified by the immediate recurrence of AF three consecutive times after cardioverting AF.Results:(1) The duration of the RF energy deliveries (P < 0.01) and total procedure time (P < 0.01) were shorter for the SePVI than the EmPVI. (2) During a mean follow‐up of 38.6 ± 23.1 months, the AF recurrence rate was 38.1% in the SePVI group and 25.7% in the EmPVI group (P = NS). (3) A redo‐ablation was performed in 25 patients, and 81.0% of the recurrent arrhythmogenic foci were found at a previously ablated PV or ipsilateral PV. (4) In 15.4% of the SePVI and 20.0% of the EmPVI procedures, AF recurred after 32.5 ± 15.2 months of the redo‐ablation. Subsequently, the AF‐free rate for each group was 88.1% (37/42) in the SePVI group and 91.4% (32/35) in the EmPVI group (P = NS).Conclusions:In patients with clearly documented arrhythmogenic PVs, the SePVI of the PV triggering the AF or an ipsilateral PV had a comparable long‐term success rate and shorter RF energy delivery and procedure times than the EmPVI.