PT  - JOURNAL ARTICLE
AU  - Shinsuke Miyazaki
AU  - Taishi Kuwahara
AU  - Atsushi Kobori
AU  - Yoshihide Takahashi
AU  - Asumi Takei
AU  - Akira Sato
AU  - Mitsuaki Isobe
AU  - Atsushi Takahashi
TI  - Long-term clinical outcome of extensive pulmonary vein isolation-based catheter ablation therapy in patients with paroxysmal and persistent atrial fibrillation
AID  - 10.1136/hrt.2009.186874
DP  - 2011 Apr 15
TA  - Heart
PG  - 668--673
VI  - 97
IP  - 8
4099  - http://heart.bmj.com/content/97/8/668.short
4100  - http://heart.bmj.com/content/97/8/668.full
SO  - Heart2011 Apr 15; 97
AB  - 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.