Heart rhythm · 2019
Ten-year ablation outcomes of patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation.
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Cheng Wen-Han, Lo Li-Wei, Lin Yenn-Jiang, Chang Shih-Lin, Hu Yu-Feng, Hung Yuan, Chung Fa-Po, Liao Jo-Nan, Tuan Ta-Chuan, Chao Tze-Fan, Tsai Tseng-Ying, Liu Shin-Huei, Chen Shih-Ann
Аннотация
BACKGROUND: Pulmonary vein isolation (PVI) is commonly performed in patients with drug-refractory symptomatic paroxysmal atrial fibrillation (PAF). However, the very long-term follow-up result is limited.
OBJECTIVE: We aimed to investigate 10-year ablation outcomes in patients with PAF and long-term follow-up results after PVI.
METHODS: This study retrospectively enrolled 176 (131 men, mean age 51.2 ± 12.1 years) patients with drug-refractory symptomatic PAF who underwent electroanatomic-guided PVI. Ten-year follow-up was completed using medical records or telephonic interviews. Procedural characteristics at index procedures and long-term clinical outcomes were investigated.
RESULTS: After a mean follow-up period of 130.0 ± 10.8 months, sinus rhythm was achieved in 102 (58%) patients after a single procedure (including 14 (8%) patients on antiarrhythmic medications) and in 88% patients after multiple procedures (including 17 (10%) patients on antiarrhythmic medications). Left atrial diameter (odds ratio 1.067; 95% confidence interval 1.009-1.127; P = .023) was the predictor of recurrent atrial tachyarrhythmia after a single ablation procedure. The single-procedure recurrence-free rates were similar between circumferential PVI and segmental PVI (59% and 50%; log-rank, P = .251). The recurrence patterns of both groups regarding the role of non-pulmonary vein and pulmonary vein triggers were similar.
CONCLUSION: The single-procedure long-term efficacy was modest, with freedom from atrial fibrillation at 10 years being 58%. Those who had enlarged left atrial diameters have more atrial tachyarrhythmia recurrences. Ten-year single-procedure outcomes of the effects of circumferential PVI and segmental PVI in patients with PAF were similar.
OBJECTIVE: We aimed to investigate 10-year ablation outcomes in patients with PAF and long-term follow-up results after PVI.
METHODS: This study retrospectively enrolled 176 (131 men, mean age 51.2 ± 12.1 years) patients with drug-refractory symptomatic PAF who underwent electroanatomic-guided PVI. Ten-year follow-up was completed using medical records or telephonic interviews. Procedural characteristics at index procedures and long-term clinical outcomes were investigated.
RESULTS: After a mean follow-up period of 130.0 ± 10.8 months, sinus rhythm was achieved in 102 (58%) patients after a single procedure (including 14 (8%) patients on antiarrhythmic medications) and in 88% patients after multiple procedures (including 17 (10%) patients on antiarrhythmic medications). Left atrial diameter (odds ratio 1.067; 95% confidence interval 1.009-1.127; P = .023) was the predictor of recurrent atrial tachyarrhythmia after a single ablation procedure. The single-procedure recurrence-free rates were similar between circumferential PVI and segmental PVI (59% and 50%; log-rank, P = .251). The recurrence patterns of both groups regarding the role of non-pulmonary vein and pulmonary vein triggers were similar.
CONCLUSION: The single-procedure long-term efficacy was modest, with freedom from atrial fibrillation at 10 years being 58%. Those who had enlarged left atrial diameters have more atrial tachyarrhythmia recurrences. Ten-year single-procedure outcomes of the effects of circumferential PVI and segmental PVI in patients with PAF were similar.