Safety and efficacy of circumferential pulmonary vein catheter ablation of atrial fibrillation.
OBJECTIVE
The purpose of this study was to report the safety, efficacy, and predictors of recurrence of circumferential pulmonary vein (PV) catheter ablation in patients with atrial fibrillation (AF).


BACKGROUND
Circumferential PV ablation has been described as an alternate ablation strategy for AF.


METHODS
Seventy consecutive patients (age 56 +/- 10 years) with symptomatic drug refractory paroxysmal (n = 21), persistent (n = 22), and permanent (n = 27) AF underwent catheter ablation. The catheter ablation procedure was performed by creating circular lesions encircling right- and left-side PV ostia guided by an electroanatomic (CARTO) mapping system. Linear ablation lesions also were created in the cavotricuspid isthmus, the mitral isthmus, and in the posterior left atrium. In 42 patients (60%), additions linear lesions were created between superior and inferior PVs in a "figure-of-eight" fashion.


RESULTS
At 6 +/- 2.5 months of follow-up, 53 patients (76%) were AF free, including 39 patients (56%) not taking and 14 patients (20%) taking antiarrhythmic drugs. Among various variables, only early recurrence of AF was a predictor of long-term recurrence. Significant complications included one pericardial tamponade, one stroke, and two PV occlusions. Both patients with PV occlusion received radiofrequency delivery in a figure-of-eight fashion.


CONCLUSIONS
Circumferential PV catheter ablation of AF is associated with moderate efficacy and risk of complications. The absence of a difference in efficacy combined with the risk of PV stenosis associated with figure-of-eight lesion lead us to conclude that the figure-of-eight lesion should not be a routine component of circumferential PV AF ablation procedures.
Vasamreddy
Chandrasekhar R
CR
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Dalal
Darshan
D
Eldadah
Zayd
Z
Dickfeld
Timm
T
Jayam
Vinod K
VK
Henrickson
Charles
C
Meininger
Glen
G
Dong
Jun
J
Lickfett
Lars
L
Berger
Ronald
R
Calkins
Hugh
H
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011667:Pulmonary Veins; D012008:Recurrence; D012449:Safety; D013997:Time Factors