title: Efficacy and late recurrences with wide electrical pulmonary vein isolation for persistent and permanent atrial fibrillation.
abstract: OBJECTIVE
  Early recurrences of atrial arrhythmia after wide electrically isolating ablation for atrial fibrillation (AF) are well described, but the long-term risk of recurrence for patients with persistent and permanent AF has not been studied in detail. METHODS AND RESULTS Fifty-six consecutive patients [45 men (80.4%), age 55.9 +/- 8.7 years] with persistent [39(69.6%)] or permanent [17(30.4%)] AF were followed for 21.6 +/- 8.8 months after ablation. Atrial fibrillation duration prior to ablation was 6.4 +/- 5.6 years. Electrically isolating lesions encircling the left and right pulmonary veins (PVs) in pairs were created. After 1.5 +/- 0.7 procedures, 48 (85.7%) had sinus rhythm (SR) at 21.6 +/- 8.8 months of follow-up: achieved with 1 procedure in 27 (56.3%) and without anti-arrhythmics in 30 (62.5%). Atrial fibrillation recurrence was observed in 69.6% after the first and 46.4% after the last procedure. Of those with late recurrences (>90 days) following the last procedure, most [18 (69.2%)] did not have early recurrences. Pre-procedural AF duration (P = 0.007) and female gender (P = 0.005) were independent predictors of recurrence following the last procedure.
  
  
  CONCLUSIONS
  Circumferential PV isolation is effective in most patients with persistent or permanent AF. However, repeat procedures are frequently required. Late recurrences are common and not precluded by the absence of early post-procedural arrhythmias.
authors.affiliation: Department of Cardiology, Westmead Hospital and The University of Sydney, NSW, Australia. seow_sc@yahoo.com
authors.forename: Swee-Chong
authors.initials: SC
authors.lastname: Seow
authors.forename: Toon-Wei
authors.initials: TW
authors.lastname: Lim
authors.forename: Choon-Hiang
authors.initials: CH
authors.lastname: Koay
authors.forename: David L
authors.initials: DL
authors.lastname: Ross
authors.forename: Stuart P
authors.initials: SP
authors.lastname: Thomas
mesh_terms: D000368:Aged; D001146:Arrhythmia, Sinus / Q000503:physiopathology / Q000517:prevention & control; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome