title: Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up.
abstract: BACKGROUND
  Paroxysmal atrial fibrillation (AF) naturally progresses toward chronic AF at an estimated rate of 15% to 30% over a 1- to 3-year period. Pulmonary vein (PV) isolation is increasingly performed for the treatment of drug-refractory paroxysmal AF. The long-term data on clinical outcome after circumferential PV isolation are limited.
  
  
  RESULTS
  From 2003 to late 2004, 161 patients (121 men; age, 59.8±9.7 years) with symptomatic paroxysmal AF and normal left ventricular function underwent circumferential PV isolation guided by 3-dimensional mapping and double Lasso technique. Right-sided and left-sided continuous circular lesions encircling the ipsilateral PVs were placed with irrigated radiofrequency energy. The procedure end point was the absence of all PV spikes for at least 30 minutes after PV isolation verified by 2 Lasso catheters placed within the ipsilateral PVs. Sinus rhythm was present in 75 patients (46.6%) after the initial procedure during a median follow-up period of 4.8 years (0.33 to 5.5 years). A second procedure was performed in 66 and a third procedure in 12 patients. Recovered PV isolation conduction was observed in 62 of 66 patients (94.0%) during the second and in 8 of 12 patients (66.7%) during the third procedure. After a median of 1 (1 to 3) procedure, stable sinus rhythm was achieved in 128 of 161 patients (79.5%), whereas clinical improvement occurred in an additional 21 of 161 patients (13.0%) during a median follow-up of 4.6 years (0.33 to 5.5 years). Four patients in stable sinus rhythm died during follow-up. Progression toward chronic AF was observed in 4 patients (2.4%); however, only 2 patients reported symptoms.
  
  
  CONCLUSIONS
  In patients with paroxysmal AF and normal left ventricular function, circumferential PV isolation results in stable sinus rhythm in the majority of patients, and low incidence of chronic AF was observed after ablation during up to 5 years of follow-up.
authors.affiliation: II Med. Abteilung, Asklepios Klinik St. Georg, Hamburg, Germany. Ouyangfeifan@aol.com
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Roland
authors.initials: R
authors.lastname: Tilz
authors.forename: Julian
authors.initials: J
authors.lastname: Chun
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.forename: Thomas
authors.initials: T
authors.lastname: Zerm
authors.forename: Kars
authors.initials: K
authors.lastname: Neven
authors.forename: Bulent
authors.initials: B
authors.lastname: Köktürk
authors.forename: Melanie
authors.initials: M
authors.lastname: Konstantinidou
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Alexander
authors.initials: A
authors.lastname: Fuernkranz
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome