title: Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: a randomized comparison between two different isolation approaches.
abstract: BACKGROUND
  Circumferential pulmonary vein ablation (CPVA) with the endpoint of pulmonary vein (PV) isolation has been developed as an effective therapy for atrial fibrillation (AF). This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions. We investigated whether the clinical outcome depends on the PV isolation approach used during the first-time CPVA procedure.
  
  
  RESULTS
  One hundred consecutive patients (69 male; age, 56.7 +/- 11.6 years) who underwent first-time CPVA for treatment of symptomatic AF were enrolled. PV isolation was randomly achieved either by CPVA alone (aggressive CPVA [A-CPVA] group, n = 50) or by a combination of CPVA with segmental PV ostia ablation (modified CPVA [M-CPVA] group, n = 50). Recurrence of atrial tachyarrhythmias (ATa) within 3 months after the initial procedure occurred in 30 patients (60%) in the M-CPVA group and in only 15 patients (30%) in the A-CPVA group (P < 0.01). ATa relapse after the first 3 months was detected in 21 patients (42%) in the M-CPVA group, compared with 9 patients (18%) in the A-CPVA group (P = 0.01). At 13 +/- 4 months, patients treated by the A-CPVA approach had greater freedom from ATa recurrence than patients who underwent M-CPVA (P = 0.01). The M-CPVA approach was the only independent predictor associated with procedural failure (RR 0.318; 95% CI 0.123-0.821; P = 0.02).
  
  
  CONCLUSIONS
  When PV isolation is the endpoint of CPVA, the efficacy of the A-CPVA approach is better than that of M-CPVA.
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing, China.
authors.forename: Xingpeng
authors.initials: X
authors.lastname: Liu
authors.forename: Jianzeng
authors.initials: J
authors.lastname: Dong
authors.forename: Hercules E
authors.initials: HE
authors.lastname: Mavrakis
authors.forename: Fuli
authors.initials: F
authors.lastname: Hu
authors.forename: Deyong
authors.initials: D
authors.lastname: Long
authors.forename: Dongping
authors.initials: D
authors.lastname: Fang
authors.forename: Ronghui
authors.initials: R
authors.lastname: Yu
authors.forename: Ribo
authors.initials: R
authors.lastname: Tang
authors.forename: Peng
authors.initials: P
authors.lastname: Hao
authors.forename: Chunshan
authors.initials: C
authors.lastname: Lu
authors.forename: Xiaokui
authors.initials: X
authors.lastname: He
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Liu
authors.forename: Panos E
authors.initials: PE
authors.lastname: Vardas
authors.forename: Changsheng
authors.initials: C
authors.lastname: Ma
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000517:prevention & control* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011667:Pulmonary Veins / Q000601:surgery*; D055502:Secondary Prevention; D016896:Treatment Outcome