title: Predictors of success after selective pulmonary vein isolation of arrhythmogenic pulmonary veins for treatment of atrial fibrillation.
abstract: 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.
authors.affiliation: University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. edward.gerstenfeld@uphs.upenn.edu
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: William
authors.initials: W
authors.lastname: Sauer
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Russo
authors.forename: Stuart
authors.initials: S
authors.lastname: Beldner
authors.forename: Melissa
authors.initials: M
authors.lastname: McKernan
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: 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