title: Radiofrequency ablation of atrial fibrillation: is the persistence of all intraprocedural targets necessary for long-term maintenance of sinus rhythm?
abstract: BACKGROUND
  Several approaches have been developed for radiofrequency catheter ablation of atrial fibrillation, but the correct intraprocedural end point is still under debate, and few data exist about the destiny of ablation lesions over time. The aim of the present study was to evaluate the long-term maintenance of intraprocedural end points of ablation procedures.
  
  
  RESULTS
  Inclusion criteria were (1) a previous ablation procedure of pulmonary vein (PV) encircling performed for drug-refractory persistent atrial fibrillation; (2) a "complete" intraprocedural end point, which consisted of voltage abatement inside the lesions, PV disconnection, and exit-block pacing from inside the lesions, attained in all PVs; and (3) stable sinus rhythm documented during a minimum follow-up of 2.5 years after the procedure. Twenty volunteers were selected (12 males, mean age 59+/-7 years) and underwent a repeat electrophysiological study. After a follow-up of 36.4+/-4.7 months, complete voltage abatement was maintained around 32 PVs (40.0%), PV disconnection persisted in 12 (37.5%) of the previously isolated PVs, and exit block was present in 39 PVs (48.7%). Ten patients who underwent a redo ablation procedure because of recurrences of atrial fibrillation were used as the control group. Differences in intraprocedural end-point maintenance between the 2 groups were not statistically significant.
  
  
  CONCLUSIONS
  Common intraprocedural end points such as voltage abatement, PV disconnection, and exit block persist only in a limited number of patients, even when the outcome is favorable during follow-up. Further investigation will be required to determine whether such data will have implications for ablation strategies.
authors: St Anna University Hospital, Corso Giovecca 203, 44100 Ferrara, Italy.
authors: Claudio
authors: C
authors: Pratola
authors: Elisa
authors: E
authors: Baldo
authors: Pasquale
authors: P
authors: Notarstefano
authors: Tiziano
authors: T
authors: Toselli
authors: Roberto
authors: R
authors: Ferrari
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D016896:Treatment Outcome