title: Role of pulmonary veins isolation in persistent atrial fibrillation ablation: the pulmonary vein isolation in persistent atrial fibrillation (PIPA) study.
abstract: BACKGROUND
  The role of pulmonary veins (PV) isolation in patients with persistent atrial fibrillation (AF) is still debated. The aim of this study was to evaluate the adjunctive role of PV isolation in patients with persistent AF who underwent circumferential PV ablation (anatomical approach).
  
  
  METHODS
  We treated 97 consecutive patients presenting with drug-refractory persistent AF by an anatomical approach (group A, n = 36, mean age = 60 +/- 8 years, 29 males) or an integrated approach (group B, n = 61, mean age 59 +/- 10 years, 48 males). In all patients, radiofrequency (RF) ablation was performed by means of a nonfluoroscopic navigation system, in order to anatomically create circumferential lines around the PV. In group B, the persistence of PV potentials was ascertained with a multipolar circular catheter. If PV potentials persisted, RF energy targeting the electrophysiological breakthroughs was delivered to disconnect the PV. Past a 2-month period of observation, success was defined as absence of any atrial tachyarrhythmia recurrence lasting >30 seconds.
  
  
  RESULTS
  Total procedure duration (220 +/- 62 minutes vs 140 +/- 43 minutes, P < 0.001), fluoroscopy time (35 +/- 15 minutes vs 17 +/- 9 minutes, P < 0.001), and RF delivery time (48 +/- 22 minutes vs 27 +/- 9 minutes, P < 0.001) were significantly longer in group B than in group A. One cardiac perforation occurred in group A. After 15 +/- 9.1 months, 21 patients in group A (58%) and 34 patients in group B (56%) were free of atrial tachyarrhythmia recurrence (P = 0.9).
  
  
  CONCLUSIONS
  In patients with persistent AF, who underwent an anatomical approach, electrophysiological confirmation of PV disconnection significantly increased the fluoroscopy and procedural times, without effect on the long-term outcomes.
authors.affiliation: Clinica Mediterranea, Naples, Italy. gmrstabile@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bertaglia
authors.forename: Pietro
authors.initials: P
authors.lastname: Turco
authors.forename: Franco
authors.initials: F
authors.lastname: Zoppo
authors.forename: Assunta
authors.initials: A
authors.lastname: Iuliano
authors.forename: Francesca
authors.initials: F
authors.lastname: Zerbo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: La Rocca
authors.forename: Antonio
authors.initials: A
authors.lastname: De Simone
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome