Immediate and long-term results of radiofrequency ablation of pulmonary vein ectopy for cure of paroxysmal atrial fibrillation using a focal approach

Abstract

Background: Atrial fibrillation (AF) is frequently initiated by focal activity originating in the pulmonary veins. We present the early and long-term results of a focal approach to pulmonary-vein ablation for cure of paroxysmal AF. Aims: The aim of this study was to establish the effectiveness of focal pulmonary vein radiofrequency ablation (RFA) for cure of paroxysmal AF. Methods: Fifty-one consecutive patients (35 male; 45 ± 11.4 years) were considered for RFA on the following criteria: (i) symptomatic drug refractory AF, (ii) high-density atrial ectopy, bursts of atrial tachycardia or AF, (iii) absence of structural heart disease and (iv) provision of informed consent. Pulmonary vein mapping and RFA were by single trans-septal puncture, which was only performed in patients with adequate focal activity at the time of procedure. Focal activity was present spontaneously or was elicited by isoprenaline, burst pacing or AF induction and cardio­version. Results: One patient was excluded from the analysis due to non-pulmonary vein triggers. Trans-septal mapping and RFA were not performed in 22 patients (44%) due to: (i) inadequate ectopy (17), (ii) recur­rent AF (1), (iii) inability to cross septum (2) and (iv) multiple foci (2). Of 28 patients, RFA was attempted with procedural success in 23 patients (82%), with no acute complications. Mean fluoro-­ scopy time for patients having RFA was 29 ± 11.5 mins. Pulmonary vein stenosis occurred in one case. Ten patients had symptomatic recurrence and, of those, two had further RFA. At a mean follow up of 11 ± 8 months, 15 patients (54% ablated, 30% of the total cohort) remained free of AF without anti-arrhythmics. Conclusion: This series highlights the low long-term success rate of RFA to cure AF by targeting pulmon­ary vein initiators using a focal approach. Electrical pulmonary vein isolation may provide better long-term results.