Is empirical four pulmonary vein isolation necessary for focally triggered paroxysmal atrial fibrillation? Comparison of selective pulmonary vein isolation versus empirical four pulmonary vein isolation

Hui Nam Pak, Jin Seok Kim, Seung Yong Shin, Hyun Soo Lee, Jong Il Choi, Hong Euy Lim, Chun Hwang, Young Hoon Kim

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Selective PV Isolation in AF. Background: We questioned whether the empirical four pulmonary vein (PV) isolation (EmPVI) was necessary in patients with paroxysmal atrial fibrillation (PAF) triggered from clearly and reproducibly defined arrhythmogenic PVs. Methods: We compared the selective or ipsilateral isolation of the PVs triggering AF (SePVI: n = 42) and EmPVI (n = 35) in 77 patients (males 80.5%, mean age 53.0 ± 13.4 years) with PAF who underwent radiofrequency catheter ablation (RFCA). Arrhythmogenic PVs were identified by the immediate recurrence of AF three consecutive times after cardioverting AF. Results: (1) The duration of the RF energy deliveries (P < 0.01) and total procedure time (P < 0.01) were shorter for the SePVI than the EmPVI. (2) During a mean follow-up of 38.6 ± 23.1 months, the AF recurrence rate was 38.1% in the SePVI group and 25.7% in the EmPVI group (P = NS). (3) A redo-ablation was performed in 25 patients, and 81.0% of the recurrent arrhythmogenic foci were found at a previously ablated PV or ipsilateral PV. (4) In 15.4% of the SePVI and 20.0% of the EmPVI procedures, AF recurred after 32.5 ± 15.2 months of the redo-ablation. Subsequently, the AF-free rate for each group was 88.1% (37/42) in the SePVI group and 91.4% (32/35) in the EmPVI group (P = NS). Conclusions: In patients with clearly documented arrhythmogenic PVs, the SePVI of the PV triggering the AF or an ipsilateral PV had a comparable long-term success rate and shorter RF energy delivery and procedure times than the EmPVI.

Original languageEnglish
Pages (from-to)473-479
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume19
Issue number5
DOIs
Publication statusPublished - 2008 May 1

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Pulmonary Veins
Atrial Fibrillation
Recurrence
Catheter Ablation

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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title = "Is empirical four pulmonary vein isolation necessary for focally triggered paroxysmal atrial fibrillation? Comparison of selective pulmonary vein isolation versus empirical four pulmonary vein isolation",
abstract = "Selective PV Isolation in AF. Background: We questioned whether the empirical four pulmonary vein (PV) isolation (EmPVI) was necessary in patients with paroxysmal atrial fibrillation (PAF) triggered from clearly and reproducibly defined arrhythmogenic PVs. Methods: We compared the selective or ipsilateral isolation of the PVs triggering AF (SePVI: n = 42) and EmPVI (n = 35) in 77 patients (males 80.5{\%}, mean age 53.0 ± 13.4 years) with PAF who underwent radiofrequency catheter ablation (RFCA). Arrhythmogenic PVs were identified by the immediate recurrence of AF three consecutive times after cardioverting AF. Results: (1) The duration of the RF energy deliveries (P < 0.01) and total procedure time (P < 0.01) were shorter for the SePVI than the EmPVI. (2) During a mean follow-up of 38.6 ± 23.1 months, the AF recurrence rate was 38.1{\%} in the SePVI group and 25.7{\%} in the EmPVI group (P = NS). (3) A redo-ablation was performed in 25 patients, and 81.0{\%} of the recurrent arrhythmogenic foci were found at a previously ablated PV or ipsilateral PV. (4) In 15.4{\%} of the SePVI and 20.0{\%} of the EmPVI procedures, AF recurred after 32.5 ± 15.2 months of the redo-ablation. Subsequently, the AF-free rate for each group was 88.1{\%} (37/42) in the SePVI group and 91.4{\%} (32/35) in the EmPVI group (P = NS). Conclusions: In patients with clearly documented arrhythmogenic PVs, the SePVI of the PV triggering the AF or an ipsilateral PV had a comparable long-term success rate and shorter RF energy delivery and procedure times than the EmPVI.",
author = "Pak, {Hui Nam} and Kim, {Jin Seok} and Shin, {Seung Yong} and Lee, {Hyun Soo} and Choi, {Jong Il} and Lim, {Hong Euy} and Chun Hwang and Kim, {Young Hoon}",
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Is empirical four pulmonary vein isolation necessary for focally triggered paroxysmal atrial fibrillation? Comparison of selective pulmonary vein isolation versus empirical four pulmonary vein isolation. / Pak, Hui Nam; Kim, Jin Seok; Shin, Seung Yong; Lee, Hyun Soo; Choi, Jong Il; Lim, Hong Euy; Hwang, Chun; Kim, Young Hoon.

In: Journal of Cardiovascular Electrophysiology, Vol. 19, No. 5, 01.05.2008, p. 473-479.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is empirical four pulmonary vein isolation necessary for focally triggered paroxysmal atrial fibrillation? Comparison of selective pulmonary vein isolation versus empirical four pulmonary vein isolation

AU - Pak, Hui Nam

AU - Kim, Jin Seok

AU - Shin, Seung Yong

AU - Lee, Hyun Soo

AU - Choi, Jong Il

AU - Lim, Hong Euy

AU - Hwang, Chun

AU - Kim, Young Hoon

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N2 - Selective PV Isolation in AF. Background: We questioned whether the empirical four pulmonary vein (PV) isolation (EmPVI) was necessary in patients with paroxysmal atrial fibrillation (PAF) triggered from clearly and reproducibly defined arrhythmogenic PVs. Methods: We compared the selective or ipsilateral isolation of the PVs triggering AF (SePVI: n = 42) and EmPVI (n = 35) in 77 patients (males 80.5%, mean age 53.0 ± 13.4 years) with PAF who underwent radiofrequency catheter ablation (RFCA). Arrhythmogenic PVs were identified by the immediate recurrence of AF three consecutive times after cardioverting AF. Results: (1) The duration of the RF energy deliveries (P < 0.01) and total procedure time (P < 0.01) were shorter for the SePVI than the EmPVI. (2) During a mean follow-up of 38.6 ± 23.1 months, the AF recurrence rate was 38.1% in the SePVI group and 25.7% in the EmPVI group (P = NS). (3) A redo-ablation was performed in 25 patients, and 81.0% of the recurrent arrhythmogenic foci were found at a previously ablated PV or ipsilateral PV. (4) In 15.4% of the SePVI and 20.0% of the EmPVI procedures, AF recurred after 32.5 ± 15.2 months of the redo-ablation. Subsequently, the AF-free rate for each group was 88.1% (37/42) in the SePVI group and 91.4% (32/35) in the EmPVI group (P = NS). Conclusions: In patients with clearly documented arrhythmogenic PVs, the SePVI of the PV triggering the AF or an ipsilateral PV had a comparable long-term success rate and shorter RF energy delivery and procedure times than the EmPVI.

AB - Selective PV Isolation in AF. Background: We questioned whether the empirical four pulmonary vein (PV) isolation (EmPVI) was necessary in patients with paroxysmal atrial fibrillation (PAF) triggered from clearly and reproducibly defined arrhythmogenic PVs. Methods: We compared the selective or ipsilateral isolation of the PVs triggering AF (SePVI: n = 42) and EmPVI (n = 35) in 77 patients (males 80.5%, mean age 53.0 ± 13.4 years) with PAF who underwent radiofrequency catheter ablation (RFCA). Arrhythmogenic PVs were identified by the immediate recurrence of AF three consecutive times after cardioverting AF. Results: (1) The duration of the RF energy deliveries (P < 0.01) and total procedure time (P < 0.01) were shorter for the SePVI than the EmPVI. (2) During a mean follow-up of 38.6 ± 23.1 months, the AF recurrence rate was 38.1% in the SePVI group and 25.7% in the EmPVI group (P = NS). (3) A redo-ablation was performed in 25 patients, and 81.0% of the recurrent arrhythmogenic foci were found at a previously ablated PV or ipsilateral PV. (4) In 15.4% of the SePVI and 20.0% of the EmPVI procedures, AF recurred after 32.5 ± 15.2 months of the redo-ablation. Subsequently, the AF-free rate for each group was 88.1% (37/42) in the SePVI group and 91.4% (32/35) in the EmPVI group (P = NS). Conclusions: In patients with clearly documented arrhythmogenic PVs, the SePVI of the PV triggering the AF or an ipsilateral PV had a comparable long-term success rate and shorter RF energy delivery and procedure times than the EmPVI.

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