Long‐Term Safety and Efficacy of Circumferential Ablation with Pulmonary Vein Isolation

Abstract

Our results suggest that the long-term single-procedure efficacy of circumferential ablation with PV isolation in a cohort of patients with predominantly nonparoxysmal AF approaches 50%. Repeat procedures involving re-isolation of the PVs result in a significant improvement in outcomes. Complete electrical isolation of the PVs has a significant impact on the long-term efficacy of the procedure.

Ablação por radiofreqüência da fibrilação atrial paroxística: fatores determinantes da eficácia clínica a longo-prazo

“…Della Bella et al 19 showed a success rate similar to ours, considering a 12-month follow-up period (65% versus 67%, respectively). Recently, Cheema et al 12,20 and Lee et al 21 presented their results based on longer follow-up periods that ranged from 11 to 30 months, achieving success rates no higher than 69% in this circumstance. In addition, some of these studies 7,12 consider success rates not only after one procedure, but summing up the positive results obtained after repeated interventions.…”

“…The literature shows varying result [7][8][9][10] , both because of differences in patient selection and because of the efficacy of these techniques 9,11,12 ; thus, there is no consensus as to which is the best therapeutic option for the control of AF patients. Also, most of these studies show results after more than one intervention and with usually short follow-up periods, thus possibly overestimating the procedural success.…”

Atrial Electroanatomical Remodeling as a Determinant of Different Outcomes Between Two Current Ablation Strategies: Circumferential Pulmonary Vein Isolation Vs Pulmonary Vein Isolation

“…When there were any PV potentials within the PVs, PV isolation was performed as previously described. 15,16 The endpoint of circumferential PVI was the absence of PV potentials in sinus rhythm, RA (rapid atrial) pacing, and/or isoproterenol infusion. An additional linear ablation of the cavotricuspid isthmus was also created by the same method of PVI previously mentioned.…”

Ablação por radiofreqüência da fibrilação atrial paroxística: fatores determinantes da eficácia clínica a longo prazo

“…Recentemente, Cheema e cols. 12,20 e Lee e cols. 21 apresentaram seus resultados baseados em tempos de seguimento maiores, que variaram de 11 a 30 meses, e nessa circunstância alcançaram taxas de sucesso não superiores a 69%.…”

“…6 chamaram a atenção para a importância das veias pulmonares na deflagração de episódios de FA, diversos estudos têm procurado determinar qual a melhor técnica a ser empregada no tratamento não-farmacológico dessa arritmia, assim como evidenciar quais fatores podem predizer a maior chance de recorrência após esses procedimentos. A literatura mostra resultados variáveis 7-10 tanto pela diferença na seleção de pacientes quanto com relação à eficácia dessas técnicas 9,11,12 , não havendo, portanto, consenso sobre qual deva ser a melhor opção terapêutica para o controle do paciente portador de FA. Ainda, a maioria desses trabalhos apresenta resultados obtidos após mais de uma intervenção e também com tempos de seguimento habitualmente curtos, possivelmente superestimando o sucesso do procedimento.…”