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RACING.and ELECTROPHYSIOLOGY www.ipej.org 6
Journal
Original Article
Short- and long-term experience in pulmonary vein
segmental ostial ablation for paroxysmal atrial fibrillation*
*English version of "Langzeit-Ergebnisse der ostialen Pulmonalvenenisolation bei
paroxysmalem Vorhofflimmern", J Kardiol 2005; 12: 231-6, "Copyright 2005 by Krause &
Pachernegg, Austria"; published with permission from publisher. Web link to the original
German version (pdf): www.kup.at/kup/pdf/5370.pdf
Purerfellner H., Aichinger J., Martinek M., Nesser H.J., Janssen J.t
Public Hospital Elisabethinen, Academic Teaching Hospital, Cardiological Department, Linz,
Austria
^Medtronic Inc. , Bakken Research Center, Maastricht, Holland
Address for correspondence: Helmut Purerfellner, MD, KH der Elisabethinen, II. Interne
AbteilungZKardiologie, Fadingerstr. 1, A-4010 Linz, Austria, Europe. E-mail:
Abstract
Introduction: Segmental ostial pulmonary vein isolation (PVI) is considered a potentially
curative therapeutic approach in the treatment of paroxysmal atrial fibrillation (PAF). There is
only limited data available on the long-term effect of this procedure.
Methods: Patients (Pts) underwent a regular clinical follow up visit at 3, 6 and 24 months after
PVI. Clinical success was classified as complete (i.e. no arrhythmia recurrences, no
antiarrhythmic drug), partial (i.e. no/only few recurrences, on drug) or as a failure (no benefit).
The clinical responder rate (CRR) was determined by combining complete and partial success.
Results: 117 patients (96 male, 21 female), aged 51±11 years (range 25 to 73) underwent a total
of 166 procedures (1.4/patient) in 2-4 pulmonary veins (PV). 115 patients (98%) had AF, 2
patients presented with regular PV atrial tachycardia. ,109/115 patients. exhibited PAF as the
primary arrhythmia (versus persistent AF). A total of 113 patients with PVI in the years 2001 to
2003 were evaluated for their CRR after 6 (3) months. A single intervention was carried out in
63 patients (55.8%), two interventions were performed in 45 patients (39.8%) and three
interventions in 5 patients (4.4%). The clinical response demonstrated a complete success of
52% (59 patients), a partial success of 26% (29 patients) and a failure rate of 22% (25 patients),
leading to a CRR of 78% (88 patients). Ostial PVI in all 4 PVs exhibited a tendency towards
higher curative success rates (54% versus 44% in patients with 3 PVs ablated for the 6 month
follow up). Long-term clinical outcome was evaluated in 39 patients with an ablation attempt at
3 PVs only (excluding the right inferior PV in our early experience) and a mean clinical follow
up of 21±6 months. At this point in time the success rate was 41% (complete, 16 patients) and
21% (partial, 8 patients), respectively, adding up to a CRR of 62% (24 patients). In total, 20
patients (17.1%) had either a single or 2 (3 patients, 2.6%) complications independent of the
number of procedures performed with PV stenosis as the leading cause (7.7%).
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 6(1): 6-16 (2006)