title: Long-term safety and efficacy of circumferential ablation with pulmonary vein isolation.
abstract: BACKGROUND
  Each of the two main approaches to catheter ablation of atrial fibrillation (AF, segmental and circumferential) is associated with moderate long-term efficacy.
  
  
  OBJECTIVE
  To report the long-term outcomes of a modified technique that combines circumferential ablation with pulmonary vein (PV) isolation, determined by a circular mapping catheter and to determine the relationship between complete PV isolation and long-term efficacy.
  
  
  METHODS
  The patient population was composed of 64 consecutive patients (47 men [73%]; age 59 +/- 11 years) with AF who underwent catheter ablation. AF was paroxysmal in 29 (45%) and nonparoxysmal in 35 (55%). Each patient was followed for a minimum of 12 months.
  
  
  RESULTS
  After a mean follow-up of 13 +/- 1 months, the long-term single-procedure success rate was 45% (n = 29) with an additional 4% (n = 3) of patients demonstrating improvement. With repeat procedures in 19 patients, the overall long-term success rate was 62% (n = 40) with 9% (n = 6) demonstrating improvement. All the patients who underwent repeat ablations had recovered PV conduction. Incomplete PV isolation was the only independent predictor of failure. A major complication occurred in four (6%) patients, including three patients with vascular complications and one with cardiac tamponade.
  
  
  CONCLUSIONS
  Our results suggest that the long-term single-procedure efficacy of circumferential ablation with PV isolation in a cohort of patients with predominantly nonparoxysmal AF approaches 50%. Repeat procedures involving re-isolation of the PVs result in a significant improvement in outcomes. Complete electrical isolation of the PVs has a significant impact on the long-term efficacy of the procedure.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0409, USA.
authors.forename: Aamir
authors.initials: A
authors.lastname: Cheema
authors.forename: Jun
authors.initials: J
authors.lastname: Dong
authors.forename: Darshan
authors.initials: D
authors.lastname: Dalal
authors.forename: Chandrasekhar R
authors.initials: CR
authors.lastname: Vasamreddy
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: Sunil
authors.initials: S
authors.lastname: Sinha
authors.forename: Henry
authors.initials: H
authors.lastname: Halperin
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome