title: Comparison of the Efficacy of Empiric Thoracic Vein Isolation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation in Patients Without Structural Heart Disease.
abstract: BACKGROUND
  The guidelines suggest that an adjuvant substrate modification in addition to pulmonary vein isolation (PVI) may be needed for persistent atrial fibrillation (PerAF) assuming that catheter ablation is less successful for PerAF than paroxysmal AF (PAF). To revisit the above assumption, we compared the outcome of the same catheter ablation strategy between PAF and PerAF.
  
  
  RESULTS
  Two hundred and thirty-three consecutive patients (mean age 60 ± 10 years, 53 PerAF and 8 long-lasting PerAF) without structural heart disease underwent catheter ablation of AF by the same strategy using an empiric thoracic vein isolation (a wide circumferential PVI plus empiric superior vena cava isolation) as a major part of the strategy without any adjuvant substrate modification. The duration of AF in the patients with PerAF was 6 ± 4 months. During 25 ± 10 months of follow-up after single procedures, 71 (30%) patients had atrial tachyarrhythmia recurrences without antiarrhythmic drugs. A Kaplan-Meier analysis of the recurrence-free survival rate after a single procedure and after repeat procedures revealed no significant difference between the patients with PAF and those with PerAF (log-rank, P = 0.38 and P = 0.27, respectively). A Cox regression multivariate analysis of the variables including the age, gender, PerAF, body mass index, left ventricular ejection fraction, and left atrial volume index demonstrated that none of the variables were an independent predictor of an atrial tachyarrhythmia recurrence after a single ablation procedure.
  
  
  CONCLUSIONS
  In patients without underlying heart disease, the procedural outcome of an empiric thoracic vein isolation is comparable for PAF and PerAF.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ejima
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Henmi
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Iwanami
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Daigo
authors.initials: D
authors.lastname: Yagishita
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Shoda
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D057186:Comparative Effectiveness Research; D018572:Disease-Free Survival; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000503:physiopathology / Q000601:surgery*
keywords: atrial fibrillation; catheter ablation; paroxysmal atrial fibrillation; persistent atrial fibrillation; pulmonary vein isolation; superior vena cava isolation; thoracic vein isolation