title: Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation: More Than a Decade of Follow-Up.
abstract: BACKGROUND
  We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up.
  
  
  RESULTS
  A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%.
  
  
  CONCLUSIONS
  In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers.
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Yalçin
authors.initials: Y
authors.lastname: Gökoğlan
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Mahmut F
authors.initials: MF
authors.lastname: Güneş
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Carola
authors.initials: C
authors.lastname: Gianni
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Issa K
authors.initials: IK
authors.lastname: Asfour
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Javier
authors.initials: J
authors.lastname: Sanchez
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.affiliation: For the author affiliations, please see the Appendix section.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: For the author affiliations, please see the Appendix section. dr.natale@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000294:innervation / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: atrial fibrillation; non-PV triggers; paroxysmal AF; pulmonary vein isolation; recurrence