Background We questioned whether the empirical four pulmonary veins(PVs) isolation(EmPVI) is superior to selective arrhythmogenic PV isolation in all patients with paroxysmal atrial fibrillation(PAF) who clearly demonstrated triggers from certain arrhythmogenic PVs.
Methods We compared the results of selective or ipsilateral isolation of PV triggering AF(SePVI) and EmPVI in 77 patients(Male 80.5%, mean age 53.0±13.4 years) with PAF who underwent 10-bipole ring catheter guided radiofrequency catheter ablation(RFCA). For SePVI(n=42), AF triggering PVs were identified by spontaneous or post-cardioversion immediate recurrence of AF, and then only PVs triggering AF or ipsilateral PV antrum were electrically isolated. For EmPVI(n=35), each PV ostium was isolated guided by PV potentials (PVP) without linear ablation. Results The total number of RF delivery was lower in SePVI than in EmPVI(51.0±16.4 vs. 127.2±60.3, p<0.01), and the total procedure time was shorter in SePVI than in EmPVI(187±79 min vs. 326±108 min, p<0.01). Among 41.6±27.8 months of follow up, recurrences after blanking period of 2 months of RFCA were similar(38.1% in SePVI group and 25.7% in EmPVI group, respectively (p=NS)). Among 16 recurrent patients in SePVI group, redo-ablation was performed in 13 patients. 53.8%(7/13) of recurrent arrhythmogenic foci was found at the previously ablated PVs with reconnected PVP, and 38.5%(5/13) recurred at ipsilateral but not previously ablated PVs. One remaining patient recurred from left inferior PV despite original AF originated from SVC. Of 9 recurred patients in EmPVI group, 8 underwent redo-ablation. We eliminated reconnected PVPs and added cavotricuspid isthmus block (3), left atrial linear (1), or focal ablation (1). After 37.5±15.2 months of redo-ablation, AF-free rate of each group was 92.9%(39/42) in SePVI and 94.3%(33/35) in EmPVI, respectively (p=NS).
Conclusion In patients with clearly documented AF triggering PVs, SePVI of PV triggering AF or ipsilateral PV antrum have comparable success rate with lower number of RF energy delivery and shorter procedure time, and similar AF free rate on long-term follow-up, compared to those of EmPVI.
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