Purerfellner H., Aichinger J., Martinek M., Nesser H.J., Janssen J, 8
“Short- and long-term experience in pulmonary vein segmental ostial ablation for
paroxysmal atrial fibrillation”
In the time period from 2001 to the first half of 2002, 3 PVs were routinely isolated, whereas
since then all 4 PVs (including the RIPV which is sometimes more difficult to reach) were
targeted during a single procedure.
Follow up
In the following we report on our experience in ostial PVI in the time period between
12/2000 and 02/2004. The last follow up visit was performed in 04/2004. After the procedure,
patients were monitored on an outpatient basis after one month and on an inpatient basis after 3,
6 and approximately 24 months. The following tests were routinely performed: Clinical
examination, Holter-ECG, evaluation of quality of life using a standardized questionnaire, in
addition (on an inpatient basis) transthoracic and transesophageal echocardiography, stress test,
spiral computed tomography (CT) of the PVs, and (only in case of significant PV stenosis)
magnetic resonance imaging of the PV and a lung scan.
Success criteria
Two distinct time periods were analyzed in order to evaluate the clinical outcome: a short
term follow up period of 6 months (3 months for the last patients in this series) and a long-term
follow up of approximately 24 months. The clinical outcome was classified as complete success
(CS) if patients were without any documented arrhythmias and free of antiarrythmic medication.
A partial success (PS) was defined by an absence of clinical symptoms while patients being still
on an antiarrhythmic drug. These two groups comprised the patient cohort for which the clinical
response rate (CRR) was calculated. A clinical failure (CF) was classified as such in the rest of
patients who showed no benefit while usually still on drug.
Results
Demographics
117 patients (96 male, 21 female) aged 51±11 years (range 25-73 years) were included
for chronic follow up. 26 patients (22%) had an underlying heart disease (hypertension n=18,
coronary artery disease n=4, diabetes n=4); 2 patients had a history of a transient ischemic
cerebral attack. Patients had used a mean number of 3.1±1.4 antiarrhythmic drugs. In most
instances several class I, II and class III drugs had been administered previously (propafenone
70%, betablocker 65%, amiodarone 56%, sotalol 51%, flecainide 26%); uncommonly, class IV
drugs (verapamil in 18% and digoxin in 14%).
Arrhythmia characteristics
Arrhythmia history showed a wide inter-individual variation and lasted for 73±67 months
(median 48 months), the maximal episode duration within the last 3 months had a median of 390
min, the mean number of arrhythmia recurrences acccounted for n=2/week. Table 1 illustrates
the classification of the preexisting arrhythmia as defined by the surface ECG. 115/117 patients
(98%) exhibited AF as their primary clinical atrial tachyarrhythmia with 86 presenting only with
PAF, 10 showing additional regularized atrial tachycardias, 14 typical atrial flutter and 5 patients
presenting both types, respectively. The majority of patients (109/115, 94.7%) presented with
PAF, 6/115 (5.3%) showed only persisting AF . Two patients (1.6%) exhibited nearly incessant
“P on T” atrial runs suggesting a pulmonary venous origin which was reconfirmed during the
ablation procedure. These 2 patients underwent pulmonary venous segmental ostial ablation and
therefore were both included in this analysis.
Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 6(1): 6-16 (2006)