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FOCUS ISSUE: ATRIAL FIBRILLATION: CLINICAL RESEARCH: ABLATION THERAPY OF ATRIAL FIBRILLATION

Long-Term Follow-Up After Cryothermic Ostial Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Wendel Moreira, MD^_*,3, Randy Manusama, MD^_*,3, Carl Timmermans, MD, PhD, FACC^_*,1, Benoit Ghaye, MD, Suzanne Philippens, RN^_*, Hein J.J. Wellens, MD, PhD, FACC^,2 and Luz-Maria Rodriguez, MD, PhD, FACC^_*,_*,1

^_* Department of Cardiology, Academic Hospital Maastricht, Maastricht, the Netherlands
Department of Medical Imaging, University Hospital of Liége, Liége, Belgium
Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.

Manuscript received June 25, 2007; revised manuscript received July 27, 2007, accepted August 17, 2007.

^_* Reprint requests and correspondence: Dr. Luz-Maria Rodriguez, Department of Cardiology, Academic Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, Maastricht, the Netherlands. (Email: lm.rodriguez{at}cardio.unimaas.nl).

Objectives: This study was designed to evaluate the long-term effect of segmental pulmonary vein (PV) cryoablation in patients with recent-onset paroxysmal atrial fibrillation (PAF).

Background: Patients with PAF have more triggers to initiate and less substrate to sustain atrial fibrillation (AF). Elimination of the potential initiators alone may be sufficient to abolish the arrhythmia.

Methods: Patients with PAF were prospectively recruited from July 2001 to July 2005. If the triggers for AF were identified, PV cryoisolation of the arrhythmogenic vein(s) was performed. Otherwise, all PVs were isolated.

Results: Seventy patients with minimal or no heart disease (54 men; age 40 ± 10 years) were enrolled. The duration of AF was 4 ± 1 year. The left ventricular ejection fraction and left atrial size were 59 ± 8% and 41 ± 5 mm, respectively. An arrhythmogenic PV was found in 10 patients (14%). Complications occurred in 3 patients (4%). No PV stenosis or esophageal injury was detected during a mean follow-up of 33 ± 15 months. Thirty-four patients (49%) achieved complete success (no AF and no antiarrhythmic drugs [AAD]); 15 patients (22%) had no recurrences with AAD; and 8 patients (11%), still with sporadic bursts of AF, improved >50% with AAD. Overall, 82% of the patients benefited from the procedure. Patients in whom the arrhythmogenic PV was identified and isolated had no recurrences.

Conclusions: Pulmonary vein cryoisolation is effective in 82% of patients with recent-onset PAF during a mean follow-up of 33 ± 15 (range 15 to 60) months. If the arrhythmogenic PV is identified and isolated, the long-term outcome is excellent, indicating no need to isolate all PVs.

Abbreviations and Acronyms   AAD = antiarrhythmic drug(s)   CT = computed tomography   PAF = paroxysmal atrial fibrillation   PV = pulmonary vein(s)   PVI = pulmonary vein isolation   RF = radiofrequency   TEE = transesophageal echocardiogram   TTM = transtelephonic telemetry

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