Stepwise Ablation For The Treatment Of Atyial Fibrillation On The Basis Of Circumferential Pulmonary Vein Ablation

[Objective]To investigate the feasibility and efficacy of a stepwise ablation procedure for the treatment of atrial fibrillation(AF)on the basis of circumferential pulmonary vein(PV)ablation guided by three dimensional mapping system(Carto).[Methods]Twelve Patients with drug-refractory paroxysmal(n=10)and persistent(n=2)atrial fibrillation were subjected to three ablation stages during one session:(1)circumferential ablation around the pulmonary vein antrum,(2) segmental pulmonary vein ablation,and(3)ablation of complex fractionated atrial electrograms(CFAEs).The endpoint of the procedure was noninducibility of AF at any stage,or completion of all three ablation stages.[Results]Ten patients with paroxysmal AF had noninducible AF at the end of the procedure:seven patients after the first stage,two after the second,and one after the third stage,respectively.Two patients with persistent AF who remained AF after all stages required external cardioversion and one had noninducible AF.Three patients had recurrent AF within two days,but were free of recurrent AF after further follow-up.One patient with paroxysmal AF and typical atrial flluter(AFL)had recurrent AFL and was free of recurrent AF.During 10±4 months of follow-up,all patients were free of recurrent AF or left atrial arrhythmias without antiarrhythmic drug therapy,and no complication occurred.Average radiofrequency energy delivery, fluoroscopy time,and procedure time were 38±11 min,37±11 min,and 3.0±0.5 hrs, respectively.[Conclusion]A stepwise ablation procedure on the basis of circumferential pulmonary vein ablation with AF noninducibilty as endpoint is effective and safe. Circumferential pulmonary vein ablation alone is enough for paroxysmal AF treatment,while circumferential pulmonary vein ablation combined with segmental pulmonary vein ablation and CFAEs ablation may result in high success rates.