Document Detail


Efficacy of repeat pulmonary vein isolation procedures in patients with recurrent atrial fibrillation.
MedLine Citation:
PMID:  15363079     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Pulmonary vein (PV) isolation is effective in the treatment of most patients with atrial fibrillation (AF). Some advocate the addition of linear ablation techniques to improve efficacy; however, previous studies suggest recurrent PV conduction is responsible for AF recurrence. The aim of this study was to determine the effectiveness of repeat PV isolation in patients with recurrent AF after an initial ablation procedure and to determine if any patient characteristics predict failure of repeat PV isolation procedures. METHODS AND RESULTS: Seventy-four patients with two or more AF ablation procedures using selective PV isolation were included. PV isolation was guided with multielectrode ring catheter recordings, electroanatomic mapping, and intracardiac electrocardiography. Radiofrequency energy was delivered using a 4-mm-tip catheter (maximum 40 W, 52 degrees C); cooled-tip ablation was performed in 10 patients. Linear ablation was not performed. Antiarrhythmic drugs were continued for at least 6 weeks after ablation; AF episodes during this period were censored. Reconnection of one or more segments of previously ablated PVs was observed in 97% of patients; reconnected PVs served as the trigger for AF in 77%. Repeat PV isolation resulted in AF control (cure or 90% reduction in AF episodes) in 64 patients (86%) over a follow-up period of 9.1 +/- 6.7 months. "High-risk" characteristics such as left atrial enlargement, persistent AF, or mitral regurgitation did not predict failure of repeat PV isolation procedures. CONCLUSION: Recurrent AF following selective PV isolation is overwhelmingly associated with PV electrical reconnection. Repeat PV isolation without linear ablation provides effective treatment for recurrent AF in patients in whom an initial PV isolation procedure failed, independent of clinical characteristics.
Authors:
David J Callans; Edward P Gerstenfeld; Sanjay Dixit; Erica Zado; Mark Vanderhoff; Jian-Fang Ren; Francis E Marchlinski
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  15     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-14     Completed Date:  2005-02-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1050-5     Citation Subset:  IM    
Affiliation:
Electrophysiology Section, Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. david.callans@uphs.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / surgery*,  ultrasonography
Body Surface Potential Mapping
Catheter Ablation
Echocardiography
Electrophysiology
Female
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Veins / surgery*,  ultrasonography
Reoperation
Treatment Failure
Treatment Outcome*
Comments/Corrections
Comment In:
J Cardiovasc Electrophysiol. 2004 Sep;15(9):1056-7   [PMID:  15363080 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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