Medium-term efficacy of segmental ostial pulmonary vein isolation for the treatment of permanent and persistent atrial fibrillation

Abstract

Introduction: Previous studies suggest that segmental ostial isolation of the pulmonary veins for the treatment of patients with persistent and permanent atrial fibrillation is associated with a high rate of recurrence. Recurrence of atrial fibrillation is usually associated with electrical reconnection of the pulmonary veins to the left atrium.

Methods: We examined the efficacy of isolating all four pulmonary veins using an open irrigated tip ablation catheter and multiple procedures, to overcome the problem of electrical reconnection in the veins. Fifty-one patients (59 +/- 10 years, 48 male) with drug resistant and highly symptomatic persistent or permanent atrial fibrillation had their pulmonary veins electrically isolated using mapping guided segmental radiofrequency ablation. Atrial fibrillation had been present for 7.6 +/- 7.3 years, and patients had failed treatment with 2.2 +/- 1.6 antiarrhythmic medications. Thirty-nine percent had structural heart disease.

Results: After a mean of 1.7 +/- 0.9 procedures per patient, 23 patients (45%) were in sinus rhythm (without cardioversion) after 16.9 +/- 9.1 months. Antiarrhythmic medications were required in four of those in sinus rhythm (17%). Recurrences were usually early (median 7 days). Neither age, duration of atrial fibrillation, type of atrial fibrillation, underlying heart disease, left atrial size, left ventricular wall thickness nor the number of failed antiarrhythmic drugs predicted outcomes.

Conclusion: Persistent and permanent atrial fibrillation can be successfully treated using segmental isolation. However, recurrence is common even when all four veins are isolated using an open irrigated tip catheter, and multiple procedures are performed. Alternative techniques are required in this population.