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Atrial electroanatomical remodeling as a determinant of different outcomes between two current ablation strategies: circumferential pulmonary vein isolation vs pulmonary vein isolation

 Hye Jin Hwang  ;  Jung Myung Lee  ;  Boyoung Joung  ;  Byung-Ho Lee  ;  Jin-Bae Kim  ;  Moon-Hyoung Lee  ;  Yangsoo Jang  ;  Sung Soon Kim 
 CLINICAL CARDIOLOGY, Vol.33(3) : 69-74, 2010 
Journal Title
Issue Date
Adult ; Aged ; Atrial Fibrillation/mortality ; Atrial Fibrillation/therapy* ; Catheter Ablation* ; Confidence Intervals ; Female ; Heart Atria/pathology* ; Heart Rate ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Prospective Studies ; Pulmonary Veins/pathology ; Pulmonary Veins/surgery* ; Recurrence ; Risk Factors ; Stroke Volume ; Treatment Outcome* ; Ventricular Function, Left
BACKGROUND: The purpose of this study was to investigate the relationship between the efficacy of the 2 different ablation techniques of atrial fibrillation (AF) and left atrial (LA) size.

METHODS AND RESULTS: A total of 81 patients with paroxysmal AF (n = 58) or persistent AF (n = 23) refractory to antiarrhythmic drugs underwent circumferential pulmonary vein isolation (PVI; n = 45) or PVI (n = 36) without respect to echocardiographic results for LA volume index (LAVI). Of the 81 patients, 41 had less dilated LA (group 1; LAVI < 27 cc/m(2)) and 40 had dilated LA (group 2; LAVI > or = 27 cc/m(2)). During the 9-month follow-up, 33 patients (73.3%) after circumferential PVI and 18 (50%) after PVI (P = .031) were free of arrhythmia. The risk of recurrence was associated with persistent AF, hypertension, LAVI > 27 ml/m(2), PVI, early recurrence of AF, and lower left ventricular (LV) ejection fraction (all P value <.05). In the univariate analysis of each group, PVI (hazard ratio [HR]: 2.92, 95% confidence interval [CI]: 0.12-7.08, P = .018) was associated with late recurrence only in group 2. Cox regression analysis also showed that PVI (HR: 5.6, 95% CI: 1.9-16.56, P = .002) was a significant independent predictor of recurrence only in group 2.

CONCLUSIONS: Circumferential PVI is more effective than PVI only in patients with a structural change of the atria, that is, a dilated LA. Our study suggests that a successful outcome in dilated LA may depend on wide modification of LA electroanatomical substrates, but wide ablation in less dilated LA may be unnecessary. Different technical strategies according to LA size are required for more a effective outcome.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Soon(김성순)
Kim, Jin Bae(김진배)
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lee, Byung Ho(이병호)
Lee, Jung Myung(이정명)
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Hwang, Hye Jin(황혜진)
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