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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

Authors
Pak, Hui-NamKim, Jin SeokShin, Seung YongLee, Hyun SooChoi, Jong IlLim, Hong EuyHwang, ChunKim, Young-Hoon
Issue Date
May-2008
Publisher
WILEY
Keywords
paroxysmal atrial fibrillation; catheter ablation; arrhythmogenic pulmonary vein
Citation
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, v.19, no.5, pp.473 - 479
Indexed
SCIE
SCOPUS
Journal Title
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
Volume
19
Number
5
Start Page
473
End Page
479
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/123651
DOI
10.1111/j.1540-8167.2007.01074.x
ISSN
1045-3873
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.
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