creators_name: Pürerfellner, H creators_name: Aichinger, J creators_name: Martinek, M creators_name: Nesser, H.J creators_name: Janssen, J editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2006-01-06 lastmod: 2011-03-11 08:56:15 metadata_visibility: show title: Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation* ispublished: pub subjects: ipej full_text_status: public keywords: atrial fibrillation; pulmonary vein ablation 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 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±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. date: 2006-01 date_type: published publication: Indian Pacing and Electrophysiology Journal volume: 6 number: 1 publisher: Indian Pacing and Electrophysiology Group pagerange: 6-16 refereed: TRUE referencetext: 1. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonaty veins. N Engl J Med 1998;339:659-666. 2. Haissaguerre M, Shah DC, Jais P et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000;102:2463-2465. 3. Karch MR, Zrenner B, Deisenhofer I, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation. A randomized comparison between 2 current ablations strategies. Circulation 2005;111:2875-2880. 4. Pappone C, Rosanio S, Augello G, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled non-randomized long-term study. J Am Coll Cardiol 2003;42:185-197. 5. Pürerfellner H, Aichinger J, Nesser HJ. Segmentale ostiale Katheterablation der Pulmonalvenen bei paroxysmalem Vorhofflimmern: Ergebnisse nach einjähriger Erfahrung. J Kardiol 2002;9(11):497-505. 6. Pürerfellner H, Cihal R, Aichinger J et al. Pulmonary vein stenosis by ostial irrigated tip ablation: incidence, time course and prediction. J Cardiovasc Electrophysiol 2003;14: 1-7. 7. Pürerfellner H, Aichinger J, Martinek M, et al. Incidence, management and outcome in significant pulmonary vein stenosis complicating ablation for atrial fibrillation. Am J Cardiol 2004;93: 1428-1431. 8. Pürerfellner H, Martinek M, Aichinger J, et al. Quality of life restored to normal in patients with atrial fibrillation after pulmonary vein ostial isolation. Am Heart J 2004;148:318-325. 9. Pürerfellner H, Aichinger J, Martinek M, et al. Quantification of atrial tachyarrhythmia burden with an implantable pacemaker before and after pulmonary vein isolation. PACE 2004;27:1277-1283. 10. Oral H, Ozaydin M, Tada H, et al. Mechanistic significance of intermittent pulmonary vein tachycardia in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2002;13:645-650. 11. Oral H, Veerareddy S, Good E, et al. Prevalence of asymptomatic recurrences of atrial fibrillation after successful radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2004;15:920-924. 12. Pappone C, Oreto G, Rosiano S, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001;104:2539-2544. 13. Oral H, Scharf C, Chugh A, et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003;108:2355-2360. citation: 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)] document_url: http://cogprints.org/4672/1/purerfellner.htm document_url: http://cogprints.org/4672/2/purerfellner.pdf