Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

More Than a Decade of Follow-Up

Yalçin Gökoǧlan, Sanghamitra Mohanty, Mahmut F. Güneş, Chintan Trivedi, Pasquale Santangeli, Carola Gianni, Issa K. Asfour, Rong Bai, J. David Burkhardt, Rodney Horton, Javier Sanchez, Steven Hao, Richard Hongo, Salwa Beheiry, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background - We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results - A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions - In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers.

Original languageEnglish (US)
Article numbere003660
JournalCirculation: Arrhythmia and Electrophysiology
Volume9
Issue number5
DOIs
StatePublished - May 1 2016

Fingerprint

Patient Isolation
Pulmonary Veins
Atrial Fibrillation
Tachycardia
Cardiac Arrhythmias
Veins
Recurrence
Superior Vena Cava
Catheter Ablation
Outcome Assessment (Health Care)

Keywords

  • atrial fibrillation
  • non-PV triggers
  • paroxysmal AF
  • pulmonary vein isolation
  • recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation : More Than a Decade of Follow-Up. / Gökoǧlan, Yalçin; Mohanty, Sanghamitra; Güneş, Mahmut F.; Trivedi, Chintan; Santangeli, Pasquale; Gianni, Carola; Asfour, Issa K.; Bai, Rong; Burkhardt, J. David; Horton, Rodney; Sanchez, Javier; Hao, Steven; Hongo, Richard; Beheiry, Salwa; Di Biase, Luigi; Natale, Andrea.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 9, No. 5, e003660, 01.05.2016.

Research output: Contribution to journalArticle

Gökoǧlan, Y, Mohanty, S, Güneş, MF, Trivedi, C, Santangeli, P, Gianni, C, Asfour, IK, Bai, R, Burkhardt, JD, Horton, R, Sanchez, J, Hao, S, Hongo, R, Beheiry, S, Di Biase, L & Natale, A 2016, 'Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation: More Than a Decade of Follow-Up', Circulation: Arrhythmia and Electrophysiology, vol. 9, no. 5, e003660. https://doi.org/10.1161/CIRCEP.115.003660
Gökoǧlan, Yalçin ; Mohanty, Sanghamitra ; Güneş, Mahmut F. ; Trivedi, Chintan ; Santangeli, Pasquale ; Gianni, Carola ; Asfour, Issa K. ; Bai, Rong ; Burkhardt, J. David ; Horton, Rodney ; Sanchez, Javier ; Hao, Steven ; Hongo, Richard ; Beheiry, Salwa ; Di Biase, Luigi ; Natale, Andrea. / Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation : More Than a Decade of Follow-Up. In: Circulation: Arrhythmia and Electrophysiology. 2016 ; Vol. 9, No. 5.
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abstract = "Background - We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results - A total of 513 paroxysmal AF patients (age 54±11 years, 73{\%} males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7{\%} of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21{\%} at 1 year, 11{\%} between 1 and 3 years, 4{\%} between 3 and 6 years, and 5.3{\%} between 6 and 12 years. Repeat procedure was performed in 74{\%} of patients. Reconnection in the PV antrum was found in 31{\%} of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87{\%}. Conclusions - In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14{\%} of patients developed recurrence because of new non-PV triggers.",
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AU - Gökoǧlan, Yalçin

AU - Mohanty, Sanghamitra

AU - Güneş, Mahmut F.

AU - Trivedi, Chintan

AU - Santangeli, Pasquale

AU - Gianni, Carola

AU - Asfour, Issa K.

AU - Bai, Rong

AU - Burkhardt, J. David

AU - Horton, Rodney

AU - Sanchez, Javier

AU - Hao, Steven

AU - Hongo, Richard

AU - Beheiry, Salwa

AU - Di Biase, Luigi

AU - Natale, Andrea

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N2 - Background - We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results - A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions - In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers.

AB - Background - We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results - A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions - In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers.

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