Outcome of Total Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

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Background: Although the efficacy of pulmonary vein (PV) isolation for paroxysmal atrial fibrillation (AF) has been well-established, its effect on persistent AF has not been sufficiently established to date. Methods and Results: In 68 consecutive patients (mean age, 52±10 years) with paroxysmal (45) and persistent (23) AF, isolation of all four PVs was performed and the subsequent clinical outcome was evaluated. In total, 268/272 PVs (99%) were completely isolated from the left atrium by radiofrequency applications. During a mean follow-up period of 11 months, 84% of patients with paroxysmal AF and 57% of patients with persistent AF were free from symptomatic AF without any antiarrhythmic drug (AAD) therapy (p=0.04). In the remaining recurrent AF patients, no significant difference between the paroxysmal and persistent AF was observed as long as they took AADs which had been ineffective at baseline (freedom from AF; 98% and 96%, respectively, p=NS). Repeat procedure performed in the 12 recurrent patients (paroxysmal AF 6, persistent AF 6) allowed 11 (92%) of them to become free from AF recurrence without AADs. Conclusion: Electrical isolation of PV by standard catheter technique is equally and highly effective for both paroxysmal and persistent AF patients, when all four PVs were isolated.
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