Is pulmonary vein isolation necessary for curing atrial fibrillation?
BACKGROUND
Pulmonary veins (PVs) play a pivotal role in initiating and perpetuating atrial fibrillation (AF). We investigated if PV electrical isolation from the left atrium is required for curing AF.


RESULTS
Fifty-one patients with paroxysmal or persistent AF underwent circumferential radiofrequency ablation of PV ostia performed with an anatomic approach. The end point of the ablation procedure was the recording of low peak-to-peak bipolar potentials (<0.1 mV) inside the lesions. Left atrium pacing was used to assess the conduction between the PVs and the left atrium. During a mean follow-up period of 16.6+/-3.9 months, 41 patients (80.4%) were free of atrial arrhythmias. When patients with and without AF recurrence were analyzed, no significant difference was observed in the mean number of PVs in which the ablation end point was reached (3.4+/-1.2 versus 3.7+/-0.87) and PVs isolated (1.5+/-1.4 versus 1.6+/-1). We noted that, although in 29 of 41 patients (71%) without AF recurrence, the ablation end point was reached in all PVs mapped, it was only possible to demonstrate the isolation of all PVs mapped in 2 patients. On the other hand, in 7 of 10 patients (70%) with AF recurrence, the ablation end point was reached in all PVs mapped, whereas one patient had all PVs isolated.


CONCLUSIONS
Our findings show that with the use of a pure anatomic approach, it is possible to prevent AF in >80% of patients undergoing catheter ablation. Moreover, the isolation of PVs is not crucial for curing AF.
Stabile
Giuseppe
G
Laboratorio di Elettrofisiologia, Casa di Cura San Michele, Via Appia 178, 81024 Maddaloni, Italia. gmrstabile@tin.it
Turco
Pietro
P
La Rocca
Vincenzo
V
Nocerino
Pasquale
P
Stabile
Eugenio
E
De Simone
Antonio
A
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents