How effective is electrical isolation of individual pulmonary veins in patients with atrial fibrillation (Afib) (AF)?

Updated: Apr 09, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

In some patients, atrial fibrillation (AF) appears to be triggered by electrically active pulmonary vein foci. [130] These patients typically have an abundance of ectopic atrial beats noted on 24-hour Holter monitoring. Electrical isolation of individual pulmonary veins, and thus the ectopic foci, is performed successfully at many centers, and patient selection is key to success.

In a study by Santangeli and colleagues, 59% of patients with paroxysmal AF who underwent a single pulmonary vein antrum isolation (PVAI) procedure were arrhythmia free by 10-year follow-up. [131]  The study involved 513 adult patients with drug-refractory paroxysmal AF, all of whom underwent catheter ablation extended to the posterior wall between the pulmonary veins.

Among those patients who underwent multiple procedures for recurrent arrhythmia, Santangeli et al reported that 87% were arrhythmia free by the 10-year mark and that the rate of late recurrence of AF was lower than those reported for segmental and less-extensive antral isolation procedures. [131]  However, nonpulmonary vein triggers causing very late recurrence of atrial arrhythmia developed in a significant number of patients.

In a follow-up study, these researchers reported similar findings: 58.7% of patients with paroxysmal AF who underwent the single procedure remained arrhythmia free survival after 12 years, with the highest rate of recurrent arrhythmia in the year 1 (21%) and the lowest rate between years 6 and 12 of follow-up (5.3%). [132] Nearly three quarters of the patients (74%) required repeat procedures, with nearly one third of these (31%) undergoing reconnection in the pulmonary vein antrum after a single procedure and none after two procedures, and another approximate 14% who developed recurrent owing to new non-pulmonary vein triggers. Overall, after multiple procedures, 87% of patients achieved freedom from recurrent AF/atrial tachycardia. [132]


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