Focal ablation versus single vein isolation for atrial tachycardia originating from a pulmonary vein.
BACKGROUND
Rapid, disorganized firing from a pulmonary vein (PV) focus may initiate atrial fibrillation. The natural history of PV atrial tachycardia (AT), resulting in a slower, more organized form of firing, is less clear. Furthermore, the optimal therapeutic approach to a PV AT is poorly defined.


OBJECTIVE
This study assessed the characteristics and long-term outcomes of focal ablation versus PV isolation for ATs arising from a single PV.


METHODS
We reviewed 886 consecutive patients who underwent an AT radiofrequency ablation at our institution from January 1997 through August 2008.


RESULTS
Twenty-six patients had focal AT with a mean cycle length of 364 +/- 90 ms that arose from within a single PV. Ten patients underwent focal ablation of their AT and 16 patients underwent PV isolation of the culprit vein. All procedures were acutely successful. The average follow-up was 25 months (range 2-90 months). There were three recurrences of AT in patients who underwent a focal ablation. There were no recurrences in patients who underwent targeted PV isolation (P = 0.046). No patients developed atrial fibrillation or AT from another focus during the follow-up period.


CONCLUSIONS
PV AT can be successfully treated with single vein isolation or focal ablation with a low risk of recurrence or the development of atrial fibrillation. PV isolation may be the preferred approach when the AT focus arises from a site distal to the ostium where targeted ablation could result in phrenic nerve injury or occlusion of a pulmonary venous branch.
Baranowski
Bryan
B
Department of Cardiovascular Medicine, Division of Electrophysiology and Cardiac Pacing, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. baranob@ccf.org
Wazni
Oussama
O
Lindsay
Bruce
B
Kanj
Mohammed
M
Saliba
Walid
W
Burkhardt
David
D
Thomas
George
G
Rickard
John
J
Tchou
Patrick
P
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome