Evaluation Of The Long-term Effect Of Circumferential Pulmonary Vein Ablation In Atrial Fibrillation

Objective: To investigate and evaluate the efficacy of circumferential pulmonary veinisolation（CPVI） in atrial fibrillation （AF） one year after operation.Methods: From March2007to January2012,39patients affected by drug-refractoryAF were admitted to the cardiovascular department of the First Affiliated Hospital ofSoochow University and received CPVI. Amony them there were24males and15females.The average age was61.1±7.96years old. Average atrial fibrillation duration was8.04±10.1years. There were31cases with paroxysmal AF,8cases with persistent AF. Therewere24cases with hypertension,5cases with diabetes mellitus,4cases with hypertrophiccardiomyopathy,2cases with hypertrophic cardiomyopathy,2cases with coronary heartdisease,2case with pulmonary heart disease. After ablation patients were followed upfor the first/third/sixth/twelfth months with routine electrocardiogram（ECG）,24hourselectrocardiogram and echocardiography.After that, every half a year had a review. If thepatients had symptoms of palpitation during follow-up, we recorded the ECG at any time.According to the follow-up results, patients were divided into2groups: group A（success group） and group B （recurrence group）. Patients in group A didn’t hasepisodes of AF,atrial flutter or atrial tachycardia without using anti-arrhythmic drugs orusing preoperative ineffective anti-arrhythmic drugs during3months after ablation,and AFepisodes load was significantly reduced. Patients in group B had recurrence of AF, atrialflutter or atrial tachycardia,and the duration was greater than or equal to30seconds. Weanalysed the effect of CPVI on AF and the relationship between recurrence and clinicalvariables including sex, age, type of AF, duration of AF, presence hypertension, Leftatrial diameter （LAD）,left ventricular ejection fraction （LVEF）、 CHA2DS2-VAScscore、Structural heart disease。Results: All cases were followed up for15~71（29.3±10.5）months.The success rate was66.7%（26/39），and the recurrence rate was33.3%（13/39） at1year.More than1year,the success rate was59.0%（23/39），and the recurrence rate was41.0%（16/39）（1with aminodarone）.During the follow-up,Ten of16cases receiving secondary ablationwere followed up for4~29months,their success was80.0%,and2cases had recurrenceof atrial arrhythmia..The total success rate was79.5%（31/39）,including8cases withrepeat procedures and1case with aminodarone.Univariate analysis revealed that nothingwas significantly related to the longer-term recurrence of AF after ablation（P<0.05）.Operation complications included pericardial tamponade（1cases）, serious vagal reflex（1case）, right lower limb deep venous thrombosis（1case） and femoral artery-veinfistula（1case）.Conclusions:1. CPVI is an effective treatment of AF.，but there are some longer-termrecurrences.2.Repeat procedures for recurrences after CPVI is still complete isolation ofpulmonary vein.