title: Pulmonary vein antral isolation and nonpulmonary vein trigger ablation without additional substrate modification for treating longstanding persistent atrial fibrillation.
abstract: BACKGROUND
  Effectiveness of antral pulmonary vein isolation (PVAI) and ablation of non-PV triggers (non-PVTA) in controlling longstanding persistent atrial fibrillation (AF) has not been reported. We sought to describe clinical outcomes with this ablation strategy in patients (pts) followed for at least 1 year.
  
  
  METHODS
  Two hundred pts underwent PVAI for longstanding persistent AF and were followed for recurrence. Thirty-three pts with <1-year follow-up and 37 pts with additional RF atrial ablation were excluded, leaving 130 pts for analysis.
  
  
  RESULTS
  All 130 pts (108 men, mean LA 4.7 ± 0.6 cm, mean AF duration of 38 ± 44 months) underwent PVAI with entrance/exit block. In addition, 24 pts (15 pts during the initial procedure and 9 additional pts at repeat ablations) had 40 non-PVTA, including 3 with AVNRT. During follow-up, atrial flutter (AFL) was noted in 7 (5%) pts. The AF-free survival after single procedure without antiarrhythmic drugs (AAD) was 38%. Repeat AF or AFL ablation was performed in 37 pts (28%) with PV reconnection uniformly identified (3.7 ± 0.5 veins/pt). During mean follow-up of 41.1 ± 23.8 months (range 12-103 months), 85/130 pts (65%) were in sinus rhythm with 65 pts (50%) off AAD, 20 pts (15%) on AAD. Additionally, 9 pts (7%) have had rare episodes of AF such that 72% of pts have had good long-term clinical outcome. Of the 36 pts with recurrent AF, 20 pts have not had a repeat procedure.
  
  
  CONCLUSIONS
  PVAI with non-PVTA for longstanding persistent AF provides good long-term AF control in over 70% of patients with infrequent (5%) AFL. AAD therapy and repeat PVAI may be required for this optimal outcome.
authors.affiliation: Hospital of the University of Pennsylvania, Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Philadelphia, PA, USA. david.lin@uphs.upenn.edu
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.forename: Edward
authors.initials: E
authors.lastname: Gerstenfeld
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Michael
authors.initials: M
authors.lastname: Riley
authors.forename: Mathew
authors.initials: M
authors.lastname: Hutchinson
authors.forename: Fermin
authors.initials: F
authors.lastname: Garcia
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Ralph
authors.initials: R
authors.lastname: Verdino
authors.forename: Joshua
authors.initials: J
authors.lastname: Cooper
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents