title: Pulmonary veins isolation to treat patients with refractory paroxysmal atrial fibrillation: clinical results after a single procedure.
abstract: OBJECTIVE
  The purpose of this study was to access the clinical outcome of patients submitted to a single procedure of radiofrequency pulmonary veins (PV) isolation to treat refractory paroxysmal atrial fibrillation (AF).
  
  
  METHODS
  This study included 49 consecutive patients (36 male; mean age 54+/-10 years old) who had frequent symptomatic paroxysmal AF refractory to at least three antiarrhythmic drugs. We used a circular decapolar catheter for mapping PVs - left atrial connections and a 4-mm distal tip catheter for ablation (30 W and 50 C), aiming to achieve electrical isolation of 3 -4 PVs.
  
  
  RESULTS
  Twenty-five patients (51%) did not present any AF recurrence in a mean follow-up of 12+/-5 months. Twenty-four (49%) had at least one recurrence during outcome; twenty (83%) of them within the first month after the procedure and four after two to nine months. After introducing antiarrhythmic drugs 15 (63%) patients were under control, 10 were asymptomatic and five complained of sporadic short duration AF episodes. Nine (37%) patients remained very symptomatic despite the use of antiarrhythmic drugs and were referred to a new procedure of PV isolation. No patient presented major complications. At the end of the follow-up, 35 (71%) patients remained in stable sinus rhythm with no AF recurrences after a single procedure, 50% of them without antiarrhythmic drugs.
  
  
  CONCLUSIONS
  Most patients who present symptomatic paroxysmal AF refractory to antiarrhythmic drugs obtain a good clinical control after a single PV isolation procedure.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. mauricio.scanavacca@incor.usp.br
authors.forename: Mauricio
authors.initials: M
authors.lastname: Scanavacca
authors.forename: Raul
authors.initials: R
authors.lastname: Sartini
authors.forename: Fernando
authors.initials: F
authors.lastname: Tondato
authors.forename: André
authors.initials: A
authors.lastname: d'Avila
authors.forename: Denise
authors.initials: D
authors.lastname: Hachul
authors.forename: Francisco
authors.initials: F
authors.lastname: Darrieux
authors.forename: Sissy
authors.initials: S
authors.lastname: Lara
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sosa
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence