title: Focal ablation versus single vein isolation for atrial tachycardia originating from a pulmonary vein.
abstract: 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.
authors.affiliation: Department of Cardiovascular Medicine, Division of Electrophysiology and Cardiac Pacing, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. baranob@ccf.org
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Bruce
authors.initials: B
authors.lastname: Lindsay
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kanj
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: David
authors.initials: D
authors.lastname: Burkhardt
authors.forename: George
authors.initials: G
authors.lastname: Thomas
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
mesh_terms: 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