title: Is empirical four pulmonary vein isolation necessary for focally triggered paroxysmal atrial fibrillation? Comparison of selective pulmonary vein isolation versus empirical four pulmonary vein isolation.
abstract: BACKGROUND
  We questioned whether the empirical four pulmonary vein (PV) isolation (EmPVI) was necessary in patients with paroxysmal atrial fibrillation (PAF) triggered from clearly and reproducibly defined arrhythmogenic PVs.
  
  
  METHODS
  We compared the selective or ipsilateral isolation of the PVs triggering AF (SePVI: n = 42) and EmPVI (n = 35) in 77 patients (males 80.5%, mean age 53.0 +/- 13.4 years) with PAF who underwent radiofrequency catheter ablation (RFCA). Arrhythmogenic PVs were identified by the immediate recurrence of AF three consecutive times after cardioverting AF.
  
  
  RESULTS
  (1) The duration of the RF energy deliveries (P < 0.01) and total procedure time (P < 0.01) were shorter for the SePVI than the EmPVI. (2) During a mean follow-up of 38.6 +/- 23.1 months, the AF recurrence rate was 38.1% in the SePVI group and 25.7% in the EmPVI group (P = NS). (3) A redo-ablation was performed in 25 patients, and 81.0% of the recurrent arrhythmogenic foci were found at a previously ablated PV or ipsilateral PV. (4) In 15.4% of the SePVI and 20.0% of the EmPVI procedures, AF recurred after 32.5 +/- 15.2 months of the redo-ablation. Subsequently, the AF-free rate for each group was 88.1% (37/42) in the SePVI group and 91.4% (32/35) in the EmPVI group (P = NS).
  
  
  CONCLUSIONS
  In patients with clearly documented arrhythmogenic PVs, the SePVI of the PV triggering the AF or an ipsilateral PV had a comparable long-term success rate and shorter RF energy delivery and procedure times than the EmPVI.
authors.affiliation: Korea University Cardiovascular Center, Seoul, Republic of Korea.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
authors.forename: Seung Yong
authors.initials: SY
authors.lastname: Shin
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Lee
authors.forename: Jong Il
authors.initials: JI
authors.lastname: Choi
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.forename: Chun
authors.initials: C
authors.lastname: Hwang
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
mesh_terms: D001281:Atrial Fibrillation / Q000517:prevention & control* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D055502:Secondary Prevention; D016896:Treatment Outcome