title: Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation*
creator: Pürerfellner, H
creator: Aichinger, J
creator: Martinek, M
creator: Nesser, H.J
creator: Janssen, J
subject: Indian Pacing and Electrophysiology Journal
description: 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±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±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±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. 
publisher: Indian Pacing and Electrophysiology Group
contributor: Singh, Balbir
contributor: Lokhandwala, Yash
contributor: Francis, Johnson
contributor: Gupta, Anup
date: 2006-01
type: Journal (Paginated)
type: PeerReviewed
format: text/html
identifier: http://cogprints.org/4672/1/purerfellner.htm
format: application/pdf
identifier: http://cogprints.org/4672/2/purerfellner.pdf
identifier:   Pürerfellner, H and Aichinger, J and Martinek, M and Nesser, H.J and Janssen, J  (2006) Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation*.  [Journal (Paginated)]     
relation: http://cogprints.org/4672/