Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation - Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation

Background- Circumferential radiofrequency ablation around pulmonary vein ( PV) ostia has recently been described as a new anatomic approach for atrial fibrillation (AF). Methods and Results-We treated 251 consecutive patients with paroxysmal (n= 179) or permanent (n=72) AF. Circular PV lesions were deployed transseptall y during sinus rhythm (n=124) or AT (n=127) using 3D electroanatonic guidan ce. Procedures lasted 148 +/- 26 minutes. Among 980 lesions surrounding ind ividual PVs (n=956) or 2 ipsilateral veins with close openings or common os tium (n=24), 75% were defined as complete by a bipolar electrogram amplitud e <0.1 mV inside the lesion and a delay > 30 ms across the line. The amount of low-voltage encircled area was 3594 +/- 449 mm(2), which accounted for 23 +/-9% of the total left atrial (LA) map surface. Major complications (ca rdiac tamponade) occurred in 2 patients (0.8%). No PV stenoses were detecte d by transesophageal echocardiography. After 10.4 +/-4.5 months, 152 patien ts with paroxysmal AF (85%) and 49 with permanent AF (68%) were AF-free. Pa tients with and without AF recurrence did not differ in age, AF duration, p revalence of heart disease, or ejection fraction, but the LA diameter was s ignificantly higher (P <0.001) in permanent AF patients with recurrence. Th e proportion of PVs with complete lesions was similar between patients with and without recurrence, but the latter had larger low-voltage encircled ar eas after radiofrequency (expressed as percent of LA surface area; P <0.001 ). Conclusions-Circumferential PV ablation is a safe and effective treatment f or AF. Its success is likely due to both PV trigger isolation and electroan atomic remodeling of the area encompassing the PV ostia.