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Long-term clinical outcome of extensive pulmonary vein isolation-based catheter ablation therapy in patients with paroxysmal and persistent atrial fibrillation
  1. Shinsuke Miyazaki1,
  2. Taishi Kuwahara1,
  3. Atsushi Kobori1,
  4. Yoshihide Takahashi1,
  5. Asumi Takei1,
  6. Akira Sato1,
  7. Mitsuaki Isobe2,
  8. Atsushi Takahashi1
  1. 1Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori, Yokosuka-shi, Kanagawa-ken, Japan
  2. 2Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
  1. Correspondence toDr Shinsuke Miyazaki, Cardiovascular Center, Yokosuka Kyosai Hospital,1-16, Yonegahamadori, Yokosuka, Kanagawa 238-8558, Japan; mshinsuke{at}


Objective To examine the long-term clinical outcomes of patients undergoing catheter ablation (CA) for either paroxysmal (PAF) or persistent atrial fibrillation (PsAF) using an extensive pulmonary vein isolation (EPVI)-based strategy.

Methods and results 574 patients (61±9 years; 449 men) with drug-refractory PAF or PsAF underwent CA. Ipsilateral pulmonary veins (PVs) were isolated with extensive antral ablation. A cavotricuspid isthmus line with bidirectional conduction block was created and all non-PV triggers of AF ablated at the index procedure. Left atrial linear ablation was performed in patients with PsAF if AF remained inducible. Patients with recurrent atrial arrhythmias had previous lesions assessed and consolidated. With mean follow up of 27±14 months after the final procedure, 480 patients (83.6%) were in sinus rhythm without antiarrhythmic drugs (1.4±0.6 procedures). The single procedure success rate without antiarrhythmic drugs was 65.5%. A late recurrence (>6 months after the initial procedure) and very late recurrence (>12 months) were seen in 1.6% and 1.7% of patients, respectively. All patients with a late recurrence had PV reconnection, with one patient also demonstrating a non-PV trigger. In comparison, non-PV triggers of AF accounted for 85.7% of very late recurrences with no evidence of PV reconduction.

Conclusions EPVI-based CA is effective in maintaining sinus rhythm in patients with PAF and PsAF over the long term. Recurrent AF after 1 year is mainly due to non-PV triggers, suggestive of an ongoing pathological process.

  • Atrial fibrillation
  • catheter ablation
  • extensive pulmonary vein isolation
  • double lasso technique
  • long-term follow-up
  • atrial arrhythmias

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  • See Editorial, p 610

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committee of Yokosuka Kyosai Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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