@misc{cogprints4672, volume = {6}, number = {1}, month = {January}, author = {H P{\"u}rerfellner and J Aichinger and M Martinek and H.J Nesser and J Janssen}, note = {*English version of "Langzeit-Ergebnisse der ostialen Pulmonalvenenisolation bei paroxysmalem Vorhofflimmern", J Kardiol 2005; 12: 231-6, "Copyright 2005 by Krause \& Pachernegg, Austria"; published with permission from publisher. Web link to the original German version (pdf): www.kup.at/kup/pdf/5370.pdf }, editor = {Balbir Singh and Yash Lokhandwala and Johnson Francis and Anup Gupta}, title = {Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation*}, publisher = {Indian Pacing and Electrophysiology Group}, year = {2006}, journal = {Indian Pacing and Electrophysiology Journal}, pages = {6--16}, keywords = { atrial fibrillation; pulmonary vein ablation}, url = {http://cogprints.org/4672/}, abstract = {Introduction: Segmental ostial pulmonary vein isolation (PVI) is considered a potentially curative therapeutic approach in the treatment of paroxysmal atrial fibrillation (PAF). There is only limited data available on the long-term effect of this procedure. Methods: Patients (Pts) underwent a regular clinical follow up visit at 3, 6 and 24 months after PVI. Clinical success was classified as complete (i.e. no arrhythmia recurrences, no antiarrhythmic drug), partial (i.e. no/only few recurrences, on drug) or as a failure (no benefit). The clinical responder rate (CRR) was determined by combining complete and partial success. Results: 117 patients (96 male, 21 female), aged 51{$\pm$}11 years (range 25 to 73) underwent a total of 166 procedures (1.4/patient) in 2-4 pulmonary veins (PV). 115 patients (98\%) had AF, 2 patients presented with regular PV atrial tachycardia. ,109/115 patients. exhibited PAF as the primary arrhythmia (versus persistent AF). A total of 113 patients with PVI in the years 2001 to 2003 were evaluated for their CRR after 6 (3) months. A single intervention was carried out in 63 patients (55.8\%), two interventions were performed in 45 patients (39.8\%) and three interventions in 5 patients (4.4\%). The clinical response demonstrated a complete success of 52\% (59 patients), a partial success of 26\% (29 patients) and a failure rate of 22\% (25 patients), leading to a CRR of 78\% (88 patients). Ostial PVI in all 4 PVs exhibited a tendency towards higher curative success rates (54\% versus 44\% in patients with 3 PVs ablated for the 6 month follow up). Long-term clinical outcome was evaluated in 39 patients with an ablation attempt at 3 PVs only (excluding the right inferior PV in our early experience) and a mean clinical follow up of 21{$\pm$}6 months. At this point in time the success rate was 41\% (complete, 16 patients) and 21\% (partial, 8 patients), respectively, adding up to a CRR of 62\% (24 patients). In total, 20 patients (17.1\%) had either a single or 2 (3 patients, 2.6\%) complications independent of the number of procedures performed with PV stenosis as the leading cause (7.7\%). Conclusion: The CRR of patients with medical refractory PAF in our patient cohort is 78\% at the 6 month follow up. PV stenosis is the main cause for procedure-related complications. Ablation of all 4 PV exhibits a tendency towards higher complete success rates despite equal CRR. Calculation of the clinical response after a mid- to long-term follow of 21{$\pm$}6 months in those patients with an ostial PVI in only 3 pulmonary veins (sparing the right inferior PV) shows a further reduction to 62\%, exclusively caused by a drop in patients with a former partial success. To evaluate the long-term clinical benefit of segmental ostial PVI in comparison with other ablation techniques, more extended follow up periods are mandatory, including a larger study cohort and a detailed description of procedural parameters. } }