Long-term safety and efficacy of circumferential ablation with pulmonary vein isolation

Aamir Cheema, Jun Dong, Darshan Dalal, Chandrasekhar R. Vasamreddy, Joseph E. Marine, Charles A. Henrikson, David Spragg, Alan Cheng, Saman Nazarian, Sunil Sinha, Henry Halperin, Ronald Berger, Hugh Calkins

    Research output: Contribution to journalArticle

    101 Scopus citations

    Abstract

    Background: Each of the two main approaches to catheter ablation of atrial fibrillation (AF, segmental and circumferential) is associated with moderate long-term efficacy. Objective: To report the long-term outcomes of a modified technique that combines circumferential ablation with pulmonary vein (PV) isolation, determined by a circular mapping catheter and to determine the relationship between complete PV isolation and long-term efficacy. Methods: The patient population was composed of 64 consecutive patients (47 men [73%]; age 59 ± 11 years) with AF who underwent catheter ablation. AF was paroxysmal in 29 (45%) and nonparoxysmal in 35 (55%). Each patient was followed for a minimum of 12 months. Results: After a mean follow-up of 13 ± 1 months, the long-term single-procedure success rate was 45% (n = 29) with an additional 4% (n = 3) of patients demonstrating improvement. With repeat procedures in 19 patients, the overall long-term success rate was 62% (n = 40) with 9% (n = 6) demonstrating improvement. All the patients who underwent repeat ablations had recovered PV conduction. Incomplete PV isolation was the only independent predictor of failure. A major complication occurred in four (6%) patients, including three patients with vascular complications and one with cardiac tamponade. Conclusion: Our results suggest that the long-term single-procedure efficacy of circumferential ablation with PV isolation in a cohort of patients with predominantly nonparoxysmal AF approaches 50%. Repeat procedures involving re-isolation of the PVs result in a significant improvement in outcomes. Complete electrical isolation of the PVs has a significant impact on the long-term efficacy of the procedure.

    Original languageEnglish (US)
    Pages (from-to)1080-1085
    Number of pages6
    JournalJournal of cardiovascular electrophysiology
    Volume17
    Issue number10
    DOIs
    StatePublished - Oct 1 2006

    Keywords

    • Atrial fibrillation
    • Catheter ablation
    • Pulmonary vein

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

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    Cheema, A., Dong, J., Dalal, D., Vasamreddy, C. R., Marine, J. E., Henrikson, C. A., Spragg, D., Cheng, A., Nazarian, S., Sinha, S., Halperin, H., Berger, R., & Calkins, H. (2006). Long-term safety and efficacy of circumferential ablation with pulmonary vein isolation. Journal of cardiovascular electrophysiology, 17(10), 1080-1085. https://doi.org/10.1111/j.1540-8167.2006.00569.x