Predictors of success after selective pulmonary vein isolation of arrhythmogenic pulmonary veins for treatment of atrial fibrillation.
BACKGROUND
Atrial fibrillation (AF) ablation procedures typically involve isolation of all pulmonary veins (PVs) in addition to adjunctive linear lesions, yet the need for such an extensive ablation strategy in all patients is unclear.


OBJECTIVE
The purpose of this study was to identify a subgroup of patients undergoing AF ablation with good clinical success after limited PV isolation.


METHODS
Patients (N = 450) underwent trigger-guided segmental isolation of only arrhythmogenic PVs. We compared clinical characteristics of patients who required isolation of only one or two PVs to those in whom AF ablation required isolating > or = 3 PVs.


RESULTS
For the group of patients undergoing isolation of < or = 2 PVs, AF freedom without antiarrhythmic drug use was achieved in 56 (58%) of 97 patients, and AF control was achieved in 66 (68%) of 97 patients after a single procedure. After additional procedures, 77 (79%) of 97 patients achieved complete AF freedom without antiarrhythmic drugs, and 82 (85%) of 97 patients achieved AF control. Younger age (odds ratio [OR] 1.05; confidence interval [CI] 1.01,1.09) and lack of persistent AF (OR 3.27; CI 1.0, 10.7) were each independent predictors of freedom from AF. In patients younger than 50 years with paroxysmal AF undergoing isolation of < or = 2 PVs (n = 44), AF freedom without antiarrhythmic drugs was achieved in 32 (73%) of 44 after a single ablation procedure.


CONCLUSIONS
Targeted PV isolation has a good long-term (18-month) success rate in patients younger than 50 years with paroxysmal AF and < or = 2 PVs triggering AF.
Gerstenfeld
Edward P
EP
University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. edward.gerstenfeld@uphs.upenn.edu
Sauer
William
W
Callans
David J
DJ
Dixit
Sanjay
S
Lin
David
D
Russo
Andrea M
AM
Beldner
Stuart
S
McKernan
Melissa
M
Marchlinski
Francis E
FE
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome