--- 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. altloc: - http://www.ipej.org/0601/purerfellner.htm chapter: ~ commentary: ~ commref: ~ confdates: ~ conference: ~ confloc: ~ contact_email: ~ creators_id: [] creators_name: - family: Pürerfellner given: H honourific: '' lineage: '' - family: Aichinger given: J honourific: '' lineage: '' - family: Martinek given: M honourific: '' lineage: '' - family: Nesser given: H.J honourific: '' lineage: '' - family: Janssen given: J honourific: '' lineage: '' date: 2006-01 date_type: published datestamp: 2006-01-06 department: ~ dir: disk0/00/00/46/72 edit_lock_since: ~ edit_lock_until: ~ edit_lock_user: ~ editors_id: [] editors_name: - family: Singh given: Balbir honourific: '' lineage: '' - family: Lokhandwala given: Yash honourific: '' lineage: '' - family: Francis given: Johnson honourific: '' lineage: '' - family: Gupta given: Anup honourific: '' lineage: '' eprint_status: archive eprintid: 4672 fileinfo: /style/images/fileicons/text_html.png;/4672/1/purerfellner.htm|/style/images/fileicons/application_pdf.png;/4672/2/purerfellner.pdf full_text_status: public importid: ~ institution: ~ isbn: ~ ispublished: pub issn: ~ item_issues_comment: [] item_issues_count: 0 item_issues_description: [] item_issues_id: [] item_issues_reported_by: [] item_issues_resolved_by: [] item_issues_status: [] item_issues_timestamp: [] item_issues_type: [] keywords: ' atrial fibrillation; pulmonary vein ablation' lastmod: 2011-03-11 08:56:15 latitude: ~ longitude: ~ metadata_visibility: show 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\n" number: 1 pagerange: 6-16 pubdom: TRUE publication: Indian Pacing and Electrophysiology Journal publisher: Indian Pacing and Electrophysiology Group 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. 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Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003;108:2355-2360. relation_type: [] relation_uri: [] reportno: ~ rev_number: 14 series: ~ source: ~ status_changed: 2007-09-12 17:01:31 subjects: - ipej succeeds: ~ suggestions: ~ sword_depositor: ~ sword_slug: ~ thesistype: ~ title: 'Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation*' type: journalp userid: 4424 volume: 6