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Europace Advance Access originally published online on October 8, 2007
Europace 2007 9(12):1129-1133; doi:10.1093/europace/eum219
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

ATRIAL FIBRILLATION

Efficacy and late recurrences with wide electrical pulmonary vein isolation for persistent and permanent atrial fibrillation

Swee-Chong Seow*, Toon-Wei Lim, Choon-Hiang Koay, David L. Ross and Stuart P. Thomas

Department of Cardiology, Westmead Hospital and The University of Sydney, NSW, Australia

Aims: Early recurrences of atrial arrhythmia after wide electrically isolating ablation for atrial fibrillation (AF) are well described, but the long-term risk of recurrence for patients with persistent and permanent AF has not been studied in detail.

Methods and results: Fifty-six consecutive patients [45 men (80.4%), age 55.9 ± 8.7 years] with persistent [39(69.6%)] or permanent [17(30.4%)] AF were followed for 21.6 ± 8.8 months after ablation. Atrial fibrillation duration prior to ablation was 6.4 ± 5.6 years. Electrically isolating lesions encircling the left and right pulmonary veins (PVs) in pairs were created. After 1.5 ± 0.7 procedures, 48 (85.7%) had sinus rhythm (SR) at 21.6 ± 8.8 months of follow-up: achieved with 1 procedure in 27 (56.3%) and without anti-arrhythmics in 30 (62.5%). Atrial fibrillation recurrence was observed in 69.6% after the first and 46.4% after the last procedure. Of those with late recurrences (>90 days) following the last procedure, most [18 (69.2%)] did not have early recurrences. Pre-procedural AF duration (P = 0.007) and female gender (P = 0.005) were independent predictors of recurrence following the last procedure.

Conclusion: Circumferential PV isolation is effective in most patients with persistent or permanent AF. However, repeat procedures are frequently required. Late recurrences are common and not precluded by the absence of early post-procedural arrhythmias.

Key Words: Atrial fibrillation, Persistent, Ablation, Pulmonary veins, Efficacy, Arrhythmia recurrences

* Corresponding author: Department of Cardiology, National University Hospital, Level 3 Main Building, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. Tel: +65 67725211; fax: +65 68722998. E-mail address: seow_sc{at}yahoo.com, seowsweechong{at}gmail.com

Manuscript submitted 22 May 2007. Accepted after revision 3 September 2007.


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