Long-term follow-up after cryothermic ostial pulmonary vein isolation in paroxysmal atrial fibrillation.
OBJECTIVE
This study was designed to evaluate the long-term effect of segmental pulmonary vein (PV) cryoablation in patients with recent-onset paroxysmal atrial fibrillation (PAF).


BACKGROUND
Patients with PAF have more triggers to initiate and less substrate to sustain atrial fibrillation (AF). Elimination of the potential initiators alone may be sufficient to abolish the arrhythmia.


METHODS
Patients with PAF were prospectively recruited from July 2001 to July 2005. If the triggers for AF were identified, PV cryoisolation of the arrhythmogenic vein(s) was performed. Otherwise, all PVs were isolated.


RESULTS
Seventy patients with minimal or no heart disease (54 men; age 40 +/- 10 years) were enrolled. The duration of AF was 4 +/- 1 year. The left ventricular ejection fraction and left atrial size were 59 +/- 8% and 41 +/- 5 mm, respectively. An arrhythmogenic PV was found in 10 patients (14%). Complications occurred in 3 patients (4%). No PV stenosis or esophageal injury was detected during a mean follow-up of 33 +/- 15 months. Thirty-four patients (49%) achieved complete success (no AF and no antiarrhythmic drugs [AAD]); 15 patients (22%) had no recurrences with AAD; and 8 patients (11%), still with sporadic bursts of AF, improved >50% with AAD. Overall, 82% of the patients benefited from the procedure. Patients in whom the arrhythmogenic PV was identified and isolated had no recurrences.


CONCLUSIONS
Pulmonary vein cryoisolation is effective in 82% of patients with recent-onset PAF during a mean follow-up of 33 +/- 15 (range 15 to 60) months. If the arrhythmogenic PV is identified and isolated, the long-term outcome is excellent, indicating no need to isolate all PVs.
Moreira
Wendel
W
Department of Cardiology, Academic Hospital Maastricht, Maastricht, the Netherlands.
Manusama
Randy
R
Timmermans
Carl
C
Ghaye
Benoit
B
Philippens
Suzanne
S
Wellens
Hein J J
HJ
Rodriguez
Luz-Maria
LM
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D013997:Time Factors