Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up
BACKGROUND For the past decade , electric pulmonary vein isolation ( PVI ) has become a procedure implemented worldwide for the treatment of atrial fibrillation .
Currently , 2 main approaches are used for PVI : ostial isolation of the PVs and wide antral PVI .
The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications .
Selective segmental ostial ablation and circumferential pulmonary veins ablation. Results of an individualized strategy to cure refractory atrial fibrillation
Aims Previous studies have analyzed the efficacy of atrial fibrillation (  AF )  ablation in series of consecutive patients or comparing methods in a r and omized way , without taking account individual patient characteristics . The purpose of this study was to evaluate the results of a strategy based on selecting the ablation method according to patient clinical features in drug-refractory paroxysmal or persistent AF . Methods and results Patients with left atrial diameter ≤40 mm and runs of atrial tachycardia of more than ten beats during Holter recording were selected for selective segmental ostial ablation ( SSOA ) in order to disconnect only those pulmonary veins with electrical potentials . The remaining patients underwent circumferential pulmonary veins ablation ( CPVA ) to modify left atrial substrate by extensive linear lesions . A group of 131 consecutive patients were included . Mean follow-up was 21.5 ± 15.2 months . In paroxysmal AF , 44 and 55 patients were selected for SSOA and CPVA , respectively , and the efficacy of the procedure was similar in the two groups ( 77 vs 74 % ; log-rank test p = NS ) . In persistent AF , 6 and 26 patients underwent SSOA and CPVA , respectively , and greater efficacy was observed in the second group ( 17 vs 65 % ; log-rank test p = 0.004 ) . Conclusions Selecting the ablation method according to patient characteristics achieved good results and reduced the overall amount of ablated atrial tissue in patients with paroxysmal AF . However , in persistent AF the SSOA technique showed very limited efficacy despite the previous patient selection and a CPVA-like procedure may be the appropriate choice in all cases
Our primary finding is that PVI performed with a wide antral approach is more effective than ostial PVI in achieving freedom from total atrial tachyarrhythmia recurrence at long-term follow-up
BACKGROUND For the past decade , electric pulmonary vein isolation ( PVI ) has become a procedure implemented worldwide for the treatment of atrial fibrillation .
Currently , 2 main approaches are used for PVI : ostial isolation of the PVs and wide antral PVI .
The aims of this systematic review are to evaluate the relative merits of each technique with a pooled comparative analysis of efficacy and complications .