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Biomedical subjects

Isabel Deisenhofer

Publications and source records attributed to Isabel Deisenhofer.

At least 19 recordsLinked to original sources
PubMed2006

Effects of circumferential or segmental pulmonary vein ablation for paroxysmal atrial fibrillation on cardiac autonomic function.

BACKGROUND: Circumferential and segmental pulmonary vein ablations are two established treatment strategies for ablation of atrial fibrillation. Both techniques require the application of radiofrequency current at anatomical sites that are close to autonomic ganglia. However, the effects of current pulmonary vein ablation techniques on cardiac autonomic function are unknown. OBJECTIVE: The purpose of this study was to analyze the short- and long-term effects of circumferential and segmental pulmonary vein ablation on cardiac autonomic function. METHODS: One hundred patients with highly symptomatic atrial fibrillation were randomly assigned to undergo either circumferential or segmental pulmonary vein ablation. Holter recordings were recorded at baseline and at regular intervals for up to 1 year after ablation. Autonomic function was assessed by deceleration capacity and acceleration capacity of heart rate as well as by standard measures of heart rate variability. RESULTS: In the circumferential pulmonary vein ablation group, deceleration capacity and acceleration capacity decreased highly significantly from 5.7 +/- 2.1 ms and -8.0 +/- 1.9 ms at baseline to 3.3 +/- 1.8 ms and -5.5 +/- 2.3 ms directly after ablation, respectively (P<.00001). Impairment of deceleration capacity and acceleration capacity was present up to 1 year after ablation. In the segmental pulmonary vein ablation group, deceleration capacity and acceleration capacity decreased from 5.8 +/- 2.0 ms and -7.8 +/- 1.6 ms at baseline to 3.4 +/- 1.2 ms and -6.0 +/- 2.4 ms directly after ablation (P<.00001), respectively. However, deceleration capacity and acceleration capacity returned to baseline values within 1 month. CONCLUSIONS: Circumferential and segmental pulmonary vein ablations induce an immediate decrease of autonomic function. However, while this decrease is only transient with segmental pulmonary vein ablation, it persists with circumferential pulmonary vein ablation for at least 1 year.

Aged↗
PubMed2006

Electrical isolation of pulmonary veins in patients with atrial fibrillation: reduction of fluoroscopy exposure and procedure duration by the use of a non-fluoroscopic navigation system (NavX).

AIMS: The aim of the study was to investigate the feasibility of performing segmental pulmonary vein (PV) isolation guided by the NavX (Endocardial Solutions, St Jude Medical, Inc., St Paul, MN, USA) system without the three-dimensional (3D) geometric reconstruction option and whether the use of NavX system will reduce the radiation exposure and procedure duration. METHODS AND RESULTS: The study included 64 patients with symptomatic paroxysmal or permanent atrial fibrillation, in whom PV isolation was performed using fluoroscopic guidance (n=32) or the NavX system (n=32). Pulmonary vein mapping with a circular mapping catheter allowed the identification and localization of myocardial connections between the PV and the left atrium. PV isolation was performed by radiofrequency ablation of these connections at the atrial aspect of the PV ostium. Primary success rate for isolated PVs did not differ significantly in patients ablated under fluoroscopic guidance vs. those ablated under guidance of NavX system [100/107 PVs (93.5%) vs. 120/124 PV (96.8%; P=n.s.)]. Compared with fluoroscopy guided procedures, NavX-guided procedures showed a significant reduction in the fluoroscopy time (75.8+/-24.5 vs. 38.9+/-19.3 min, P<0.05), total X-ray exposure (93.2+/-51.6 vs. 56.6+/-37.9 Gy cm(2), P=0.03), and total procedural time (237.7+/-65.4 vs. 188.6+/-62.7 min, P=0.01). The mean follow-up was 9.5+/-3.0 months. One patient in each group was lost to follow-up. Seven-day Holter monitoring showed that 23 of 31 patients (74.2%) in the NavX-guided group and 21 of 31 patients (67.7%) in the fluoroscopy-guided group were in sinus rhythm (P=0.57). CONCLUSION: The 3D visualization of the catheters by NavX system allows a rapid and precise visualization of the mapping and ablation catheters at the PV ostia and markedly reduces fluoroscopy time, total X-ray exposure, and procedural duration during PV isolation compared with ablation performed under fluoroscopy guidance.

Aged↗
PubMed2006

Mapping and ablation of atypical flutter in congenital heart disease with a novel three-dimensional mapping system (Carto Merge).

Mapping and successful ablation of an intra-atrial re-entry tachycardia in a patient after Fontan operation were performed within the anatomy, superimposed from the computed tomography study. In this case, the new system enabled us to display the complex anatomy of the right atrium in detail, whereas the conventional electro-anatomic three-dimensional geometry showed significant inconsistencies.

Adult↗
PubMed2006

Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation.

AIMS: To investigate the incidence, electrophysiological properties, and ablation results for left atrial (LA) tachycardia as a sequel to the circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF). METHODS AND RESULTS: Sixty-seven patients with AF underwent CPVA. Sustained LA tachycardia developed in 21/67 (31%) patients and in 16/21 symptomatic patients 55 LA tachycardias (3.4+/-2.4 per patient) were mapped: 18 (33%) tachycardias were related to macro-re-entry around the mitral valve (7) or pulmonary vein(s) (11). In 20 tachycardias (36%), a 'small-loop' LA re-entrant tachycardia (LART) was identified; gaps in prior ablation lines (7 LART) or an area of extremely slow conduction adjacent to the CPVA lesions (13 LART) were crucial for these re-entries. Seventeen tachycardias (31%) were too unstable for complete mapping. Ablation was a primary success in 34 of 38 (89%) mapped LART, but in eight of 21 procedures, cardioversion was necessary to achieve sinus rhythm. CONCLUSION: LART develops in a high percentage of patients after CPVA. Small-loop re-entry, which is difficult to map, may arise and patients suffer from several and/or unstable variants of LART. Thus, mapping and ablation of these LART is challenging and the overall success is yet not satisfactory.

Aged↗
PubMed2006

Atresia of the coronary sinus in patients with supraventricular tachycardia.

BACKGROUND: Atresia of the coronary sinus (CS) ostium with retrograde drainage of the cardiac veins via the persistent left superior vena cava (PLSVC) is a rare abnormality and only a few case reports in association with electrophysiological studies have been reported. METHODS: During standard electrophysiological study in three patients with a focal left atrial tachycardia, atrial fibrillation and common type right atrial flutter, the CS could not be cannulated despite several attempts. Assuming an occluded CS ostium we advanced a multipurpose catheter via the right atrium and the right superior vena cava in a PLSVC and performed CS angiography. RESULTS: CS angiography showed that the CS was occluded in all 3 patients and the PLSVC was used as a drainage route to the superior vena cava. After retrograde placement of a 2.5 Fr nonsteerable diagnostic catheter via the PLSVC in the CS, the intracardiac CS electrogram was recorded. Successful ablation could be performed in all three cases. CONCLUSIONS: The cases highlight the possibility that failure to access the CS during electrophysiological studies may be related to this anomaly and that retrograde cannulation via PLSVC enables the CS access and acquisition of its electrograms.

Aged↗
PubMed2006

Long-term follow-up of patients supplied with single-chamber or dual-chamber cardioverter defibrillators.

INTRODUCTION: In patients who have an indication for an implantable cardioverter defibrillator (ICD) a dual-chamber device is indicated in the case of concomitant significant sinus node disease or atrioventricular block. It is a matter of debate whether dual-chamber ICD may be beneficial for patients with preserved sinus and atrioventricular nodal function as data from prospective randomized trials are limited. Mid- or long-term follow-up data are unavailable. METHODS AND RESULTS: One hundred patients (age 60+/-12 years, 11 women) with the indication for the implantation of an ICD and without antibradycardia pacing indication were randomly assigned to either receive a dual-chamber ICD (n=52) or a single-chamber ICD (n=48). Patients were followed-up for a mean of 52+/-14 months. Mortality and arrhythmogenic morbidity were assessed. All-cause mortality was 21% for single-chamber and 31% for dual-chamber ICD recipients, respectively (P=0.26). Cardiovascular mortality was 13% for single-chamber ICD recipients versus 21% in the dual-chamber group (P=0.25). Subgroup analysis using 35% of ventricular paced beats as cutoff value in the dual-chamber ICD group revealed a 42% mortality rate for the patients with frequent ventricular pacing compared to 10% of patients with a low rate of ventricular pacing (P=0.05, relative risk 4.21, 95% confidence interval: 0.9-19.8). As for arrhythmogenic morbidity, the difference in the ventricular tachyarrhythmia load was not different in both groups (single chamber: 23+/-74 VT episodes, dual chamber: 54+/-134 VT episodes, P=0.17). CONCLUSION: In ICD recipients without conventional indication for dual-chamber pacing, dual chamber compared to single-chamber ICD has no advantage concerning mortality and arrhythmogenic morbidity in a long-term follow-up. In these patients the implantation of a single-chamber device is sufficient.

Arrhythmias, Cardiac↗
PubMed2005

Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies.

BACKGROUND: Data on the comparative value of the circumferential pulmonary vein and the segmental pulmonary vein ablation for interventional treatment of atrial fibrillation are limited. We hypothesized that the circumferential pulmonary vein ablation approach was superior to the segmental pulmonary vein ablation approach. METHODS AND RESULTS: One hundred patients with highly symptomatic atrial fibrillation were randomly assigned to undergo either circumferential (n=50) or segmental pulmonary vein ablation (n=50). Freedom from atrial tachyarrhythmias in a 7-day Holter monitoring at 6 months was the primary end point. Secondary end points were freedom of arrhythmia-related symptoms and a composite of pericardial tamponade, thromboembolic complications, and pulmonary vein stenosis (safety end point). On the basis of the results of the 7-day Holter monitoring at 6 months, 21 patients (42%) after circumferential pulmonary vein ablation and 33 patients (66%) after segmental pulmonary vein ablation (P=0.02) were free of atrial tachyarrhythmia episodes. During the 6-month follow-up period, 27 patients (54%) after circumferential pulmonary vein ablation and 41 patients (82%) after segmental pulmonary vein ablation remained free of arrhythmia-related symptoms (P<0.01). No significant difference was found in the safety end point (6 versus 7 events; P=0.77) in the circumferential versus segmental pulmonary vein ablation group, respectively. CONCLUSIONS: This study demonstrates no superiority of the circumferential pulmonary vein ablation over segmental pulmonary vein ablation for treatment of atrial fibrillation in terms of efficacy and safety.

Aged↗
PubMed2005

Atypical access to typical atrial flutter.

Typical atrial flutter with reentry around the tricuspid valve can easily be cured by ablating the cavotricuspid isthmus. In the reported case, transvenous access to the tricuspid valve was not possible because of a total cavopulmonal connection in congenital mitral atresia. Successful angioplasty of a small fenestration between the total cavopulmonal connection and the genuine right atrium (RA) allowed anterograde transvenous access to the RA. Electroanatomic RA mapping confirmed peritricuspid reentry, and successful ablation was performed.

Adolescent↗
PubMed2005

Rescue ablation of electrical storm in patients with ischemic cardiomyopathy: a potential-guided ablation approach by modifying substrate of intractable, unmappable ventricular tachycardias.

OBJECTIVES: The purpose of this study was to evaluate a substrate-modifying, primarily potential-guided catheter ablation approach as a bailout therapy in patients with complex myocardial infarction and electrical storms due to ventricular tachycardias (VTs). BACKGROUND: Management of electrical storm is a domain of medical treatment. A definite trigger or delineated scar has been characterized as a requirement for substrate-orientated ablation of intractable unmappable ventricular tachyarrhythmias but can be absent, as shown in the presented cases. METHODS: Five patients who presented with ischemic cardiomyopathy and severe reduced left ventricular ejection fraction also suffered from multiple types of unstable VTs that deteriorated into drug-refractory electrical storm. Patients had 96 to 580 VT episodes requiring therapy with an implantable cardioverter-defibrillator (ICD) and received 3 to 310 shock deliveries prior to ablation. Treatment with beta-blockers, amiodarone, class IB antiarrhythmic drugs, deep sedation, and overdrive pacing and/or cardioversion of incessant VTs failed to stabilize the electrical storm but enabled left ventricular electroanatomic voltage mapping. A simplified substrate modification was performed by ablation of delayed fractionated potentials in areas identified by pace mapping, matching three to eight documented types of VTs per patient in complex scar areas. RESULTS: All patients could be stabilized after ablation. During 12 to 30 months of follow-up, three patients remained free of any VT episode requiring ICD treatment, and two patients had <1 VT episode per month. CONCLUSIONS: The cases presented demonstrate that rescue VT ablation of drug-refractory electrical storm is possible by a substrate-orientated ablation approach even in patients with complex chronic infarction and various VTs.

Aged↗
PubMed2005

Catheter ablation of left atrial focal tachycardia guided by electroanatomic mapping and new insights into interatrial electrical conduction.

BACKGROUND: Experience in catheter ablation of left atrial (LA) focal tachycardia and information about interatrial electrical connections during LA focal tachycardia are limited. OBJECTIVES: The purpose of this study was to describe our experience in electroanatomic mapping-guided catheter ablation of LA focal tachycardia and to investigate interatrial electrical connections during LA focal tachycardias. METHODS: Thirty-three patients undergoing catheter ablation for LA focal tachycardia guided by electroanatomic mapping were reported. Interatrial electrical connections were analyzed in LA focal tachycardias with biatrial electroanatomic maps. RESULTS: Of the 35 LA focal tachycardias (cycle length 309 +/- 100 ms) mapped, 19 (54%) originated from the pulmonary veins (PVs), 6 (17%) from the mitral annulus, 3 (8.6%) from LA roof, 3 (8.6%) from LA posterior wall, 2 (5.7%) from LA appendage, and 2 (5.7%) from LA septum. Fourteen of the 19 PV tachycardias (74%) were located in proximity to PV ostia. In 14 (7 PV, 7 non-PV) LA focal tachycardias with biatrial electroanatomic maps, posterior right atrium breakthrough sites at the intercaval area were identified in 7 PV tachycardias and 1 non-PV tachycardia. Five of the 7 PV tachycardias used only the posterior breakthrough for interatrial propagation. Procedural success was achieved in 33 of 35 LA focal tachycardias (94%) in 31 patients. During 23 +/- 19 months of follow-up, 2 patients (6%) had recurrence of ablated tachycardia, and 3 (10%) developed new LA focal tachycardias. CONCLUSIONS: The PVs and the mitral annulus were the main sources of LA focal tachycardias. The majority of PV tachycardias originated from PV ostia. A posterior interatrial connection appeared to play a major role in interatrial electrical propagation during PV tachycardias. Electroanatomic mapping facilitated precise localization of LA focal tachycardias and achievement of a high rate of ablation success.

Adult↗
PubMed2005

Acute and long-term results of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia--an analysis of the predictive factors for arrhythmia recurrence.

BACKGROUND: Predictors of atrioventricular nodal reentrant tachycardia (AVNRT) recurrence after radiofrequency ablation including the importance of residual slow pathway conduction are not known. The aim of this study was to report the acute and long-term results of slow pathway ablation in a large series of consecutive patients with AVNRT and to analyze the potential predictors of arrhythmia recurrence with a particular emphasis on the residual slow pathway conduction after ablation. METHODS: The study included 506 consecutive patients with AVNRT (mean age 52.6 +/- 16 years, 315 women) who underwent slow pathway ablation using a combined electrophysiological and anatomical approach. The end point of ablation procedure was noninducibility of the arrhythmia. The primary end point of the study was the recurrence of AVNRT. RESULTS: Acute success was achieved in 500 patients (98.8%). After ablation, 471 patients (93%) were followed up for a mean of 903 +/- 692 days. Of the 465 patients with successful ablation, 24 patients (5.2%) developed AVNRT recurrences during the follow-up. No significant differences in the cumulative rates of AVNRT recurrence were observed in groups with or without electrophysiological evidence of residual slow pathway conduction (P = 0.25, log-rank test). Multivariate analysis identified only age as an independent predictor of AVNRT recurrence (hazard ratio 0.96, 95% confidence interval 0.94-0.99, P = 0.004) with younger patients being at an increased risk for arrhythmia recurrence. CONCLUSIONS: Our study demonstrated that only younger age, but not other clinical or electrophysiological parameters including residual slow pathway conduction predicted an increased risk for AVNRT recurrence after slow pathway radiofrequency ablation.

Adolescent↗
PubMed2004

Atrial fibrillation originating from persistent left superior vena cava.

BACKGROUND: The left superior vena cava (LSVC) is the embryological precursor of the ligament of Marshall, which has been implicated in the initiation and maintenance of atrial fibrillation (AF). Rarely, the LSVC may persist and has been associated with some organized arrhythmias, though not with AF. We report 5 patients in whom the LSVC was a source of ectopy, initiating AF. METHODS AND RESULTS: In 5 patients (4 men; age, 46+/-11 years) with symptomatic drug-refractory AF, ectopy from the LSVC resulting in AF was observed after pulmonary vein isolation. The ectopics were spontaneous in 2 and induced by isoproterenol in the others and preceded P-wave onset by 67+/-13 ms. During multielectrode or electroanatomic mapping, venous potentials were recorded circumferentially at the proximal LSVC near its junction with the coronary sinus (CS), but at the mid-LSVC level, they were recorded only on part of the circumference. The LSVC was electrically connected to the lateral left atrium (LA) and through the CS to the right atrium, with 4.1+/-2.3 CS-LSVC and 1.6+/-0.5 LA-LSVC connections per patient. Catheter ablation in the LSVC targeting these connections resulted in electrical isolation in 4 of the 5 patients without complications. After 15+/-10 months, the 4 patients with successful isolation, including 1 who had successful reablation for LA flutter, remained in sinus rhythm without drugs. CONCLUSIONS: The LSVC can be the arrhythmogenic source of AF with connections to the CS and LA. Ablation of these connections resulted in electrical isolation.

Adrenergic beta-Agonists↗
PubMed2004

Transvenous cryoablation versus radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia: a prospective randomized pilot study.

AIMS: This is a prospective, randomized study comparing transvenous cryoablation with radiofrequency (RF) ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). METHODS AND RESULTS: In this pilot trial, 200 patients with AVNRT were randomized to undergo cryoablation or RF ablation of the slow pathway. A 7 Fr 4-mm-tip cryocatheter (Cryocath) was used for cryomapping and cryoablation. Cryomapping was performed at the temperature of -30 degrees C to test the effect on the candidate ablation site. Following successful cryomapping, cryoablation was performed to produce an irreversible lesion by freezing to -75 degrees C. Procedural success, defined as elimination of the slow pathway or noninducibility of AVNRT, was achieved in 97/100 (97%) patients in the Cryo group vs. 98/100 (98%) patients in the RF group. No permanent complete AV-block occurred in either group. During a median of 246 days of follow-up, 8 patients in the Cryo group and 1 in the RF group had AVNRT recurrence. The cumulative incidence of primary endpoint (a combination of procedural failure, permanent complete AV-block and AVNRT recurrence) was significantly higher in the Cryo group than in the RF group (P=0.03, Log-rank test). CONCLUSIONS: The results of this pilot study indicate that transvenous cryoablation using a 4-mm-tip cryocatheter is associated with a comparable acute success rate but a higher recurrence rate as compared with RF ablation in patients with AVNRT. Potential benefits of cryoablation for ablation of AVNRT need to be determined in a larger multi-centre trial.

Adult↗
PubMed2004

Influence of high-pass filtering on noncontact mapping and ablation of atrial tachycardias.

The aim of the study was to define the impact of different high-pass filter settings (HPF) on the accuracy of mapping of ectopic atrial tachycardias (EAT) using a noncontact mapping (NCM) system. In 20 patients with 22 EAT a noncontact probe was deployed in the right (n = 19) or in the left atrium (n = 3). The device enables interpolation and analysis of unipolar electrograms. It provides information on focus localization and signal morphology. These parameters were compared in different HPF of 0.5 Hz, 2 Hz, 8 Hz, and 16 Hz. The NCM signal morphology was preserved at all HPF. An initial negative deflection recorded by NCM system showed a positive predictive value of 93% regarding the ablation success. The deviation (spatial disparity) between visualized focus origin and successful ablation site was 6.9 +/- 5.4 mm. Between two consecutive filter settings, the focus shift was more pronounced between 0.5 and 2 Hz (5.4 +/- 4.5 mm) compared to a setting between 8 and 16 Hz (2.9 +/- 2.9 mm; P < 0.05). Successful ablation was achieved in 15/18 right atrial tachycardias (83%) and in 2/3 left atrial arrhythmias. Different HPF influence NCM spatial analysis of EAT. However, a small variability in foci localization does not impact final ablation results.

Body Surface Potential Mapping↗
PubMed2004

Incidence of antitachycardia therapy suspension due to magnet reversion in implantable cardioverter defibrillators.

Electromagnetic interference may result in transient or persistent suspension of antitachycardia therapies in ICDs. The incidence of such events has not been assessed so far. Patient charts were retrospectively analyzed for the occurrence of temporary suspension of antitachycardia therapies as it is stored in the Holter of St. Jude Medical or Ventritex ICDs. Follow-up data of 46 patients and 83.7-patient years were analyzed. Overall, 43 episodes of transient ICD inactivation occurred. Twenty-two of these episodes were related to intentional ICD inactivation in the emergency room or during surgery and 12 episodes were related to ICD follow-up. In nine episodes an environmental source of electromagnetic interference is presumed. None of the interactions resulted in persistent ICD inactivation or reprogramming of the devices. The risk for temporary suspension of ICD therapies unrelated to surgery, intentional magnet application in the emergency room, or routine follow-up is 11% per patient and year. Evaluation of its potential sources and the prevalence of ICD inhibition is warranted.

Adolescent↗
PubMed2003

Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses.

BACKGROUND: Symptomatic prolonged sinus pauses on termination of atrial fibrillation (AF) are an indication for pacemaker implantation. We evaluated sinus node function and clinical outcome in patients with prolonged sinus pauses on termination of arrhythmia who underwent ablation of paroxysmal AF. METHODS AND RESULTS: Twenty patients with paroxysmal AF and prolonged sinus pauses (> or =3 seconds) on termination of AF underwent ablation between May 1995 and November 2002. Patients with sinus pauses independent of episodes of AF were excluded from the analysis. The procedure included pulmonary vein and linear atrial ablation. After ablation, sinus node function was assessed during the first week and at 1, 3, and 6 months, by 24-hour ambulatory monitoring to determine the mean heart rate and heart rate range, and by exercise testing to determine the maximal heart rate. Corrected sinus node recovery time was determined at the completion of ablation and at 24.0+/-11.3 months at 600 and 400 ms. After AF ablation, there was a significant improvement of sinus node function, with an increase in the mean heart rate (P=0.001), maximal heart rate (P<0.0001), and heart rate range (P<0.0001). The corrected sinus node recovery time decreased in all patients evaluated at 600 ms (P=0.016) and 400 ms (P=0.019). At 26.0+/-17.6 months, 18 patients (85%) had no recurrence of AF (in the absence of medication), with no symptoms attributable to bradycardia or sinus pauses on ambulatory monitoring. Two patients had infrequent episodes of AF, 1 requiring pacemaker implantation. CONCLUSIONS: Prolonged sinus pauses after paroxysms of AF may result from depression of sinus node function that can be eliminated by curative ablation of AF. This is accompanied by improvement in parameters of sinus node function, suggesting reverse remodeling of the sinus node.

Atrial Fibrillation↗
PubMed2003

Circumferential mapping and electric isolation of pulmonary veins in patients with atrial fibrillation.

Information about the clinical efficacy and complications of the circumferential mapping and isolation of the pulmonary veins (PVs) in patients with atrial fibrillation (AF) is still limited. The present study included 75 patients (mean age 58 +/- 11 years, 20 women) with paroxysmal (n = 69) or persistent AF (n = 6). Mapping of PVs was performed with a circumferential mapping catheter. After preferential PV-left atrium (LA) electric inputs were defined, radiofrequency ablation was performed until complete isolation of the PVs from the LA was achieved. A total of 226 PVs were mapped; 195 (86%) showed typical PV potentials. Complete isolation of PVs from the LA was achieved in 173 PVs (89%). Detailed follow-up, including 7-day Holter monitoring at 1, 4, 9, and 12 months after intervention was performed. If AF reoccurred, PVs were mapped and reisolated. After a mean follow-up period of 230 +/- 133 days, 38 of 75 patients (51%) were in sinus rhythm. At 1, 4, and 9 months of follow-up, 31 of 65 patients (48%), 36 of 53 patients (68%, p = 0.04 as compared with the first month), and 21 of 28 patients (75%, p = 0.025 as compared with the first month), respectively, were in sinus rhythm. During follow-up, 30 patients (40%) underwent a second ablation procedure due to recurrence. Recurrences were related to resumption of PV muscle-left atrial conduction (27 patients) and/or extra PV foci (12 patients) or nonablated PVs (8 patients). Complications occurred in 17 patients (22%). PV stenosis was detected in 13 patients (25% to 50% in 7 patients and >50% in 6 patients). Pericardial effusion occurred in 4 patients. It was concluded that isolation of the PV from the LA is moderately effective in the prevention of AF recurrence and could be associated with serious acute and long-term complications.

Adult↗