Wen-Han Cheng1, Li-Wei Lo2, Yenn-Jiang Lin3, Shih-Lin Chang3, Yu-Feng Hu3, Yuan Hung4, Fa-Po Chung3, Jo-Nan Liao3, Ta-Chuan Tuan3, Tze-Fan Chao3, Tseng-Ying Tsai1, Shin-Huei Liu1, Shih-Ann Chen3. 1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 2. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan. Electronic address: gyrus@ms65.hinet.net. 3. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan. 4. Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Abstract
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.
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.
Authors: Aikaterini Vraka; José Moreno-Arribas; Juan M Gracia-Baena; Fernando Hornero; Raúl Alcaraz; José J Rieta Journal: J Cardiovasc Dev Dis Date: 2022-06-01
Authors: Aikaterini Vraka; Vicente Bertomeu-González; Lorenzo Fácila; José Moreno-Arribas; Raúl Alcaraz; José J Rieta Journal: J Pers Med Date: 2022-03-14