Pulmonary vein ablation for idiopathic atrial fibrillation: six month outcome of first procedure in 100 consecutive patients

Objectives: To report six month outcome in patients undergoing their first pulmonary vein ablation procedure for idiopathic atrial fibrillation (AF) at a "non-pioneering'' hospital. Design: Prospective observational study. Setting: Specialist electrophysiology unit at a university hospital. Patients: The first 100 consecutive patients undergoing their first pulmonary vein catheter ablation procedure for highly symptomatic, drug resistant AF in the period 1999 - 2002. Main outcome measures: Incidence of symptomatic or asymptomatic, Holter documented AF six months after ablation. Results: Mean patient age was 52 years ( range 23 - 73 years), mean length of AF history 53 months ( range 6 - 180 months), mean number of antiarrhythmic drug failures was 3 ( range 1 - 5), and 81 were men. At the time of the ablation procedure, 64 had progressed to persistent AF and 23 had increased transverse left atrial diameter. The number of pulmonary veins ablated in each patient was one in 11, two in 45, three in 36, and four in 8. Six months after ablation, 55 patients were consistently in sinus rhythm, asymptomatic, and without any Holter evidence of AF. The chance of being in sinus rhythm was 73% ( 29 of 64) in those with paroxysmal as compared with only 45% ( 26 of 36) in those with persistent AF at the time of ablation ( p = 0.01). Outcome was not influenced by patient age, length of AF history, or duration of persistent AF before ablation or to left atrial dimension. Follow up was complete and no patient has died or experienced a stroke during or after ablation; nor have any developed symptoms of late pulmonary vein stenosis. However, other complications occurred during or shortly after the procedure in 12 patients, including cardiac tamponade in six. Conclusions: In selected patients with drug resistant AF, focal pulmonary vein catheter ablation offers a realistic prospect of achieving stable sinus rhythm compared with alternatives. However, it is a complex form of ablation with a significant risk of serious complications. Although a new milestone in arrhythmia management, the optimum ablation technique is still evolving and any impact on the natural history of AF remains to be determined.