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 .
Distinctive Electrophysiological Properties of Pulmonary Veins in Patients With Atrial Fibrillation
Background —Atrial fibrillation ( AF ) is frequently initiated from pulmonary veins ( PVs ) , but little is known of the electrophysiological properties of PVs . Methods and Results —Two groups were studied : 28 patients ( 49±13 years old ) with paroxysmal AF and 20 control patients ( 49±14 years old ) without AF . Effective and functional refractory period and conduction time from PV to left atrium ( LA ) were compared in the 2 groups by use of programmed stimulation with a single extrastimulus in the PVs and LA . In the AF group , the venous effective refractory periods ( ERPs ) were shorter than that of the LA : 185±71 versus 253±21 ms , P < 0.001 , whereas in the control group , they were longer ( 282±45 versus 253±41 ms , P = 0.009 ) . The venous ERPs and functional refractory periods in patients with AF were also shorter than that observed in control subjects ( 185±71 versus 282±45 ms and 210±77 versus 315±43 ms , respectively , P < 0.001 ) , whereas LA ERPs were not significantly different . Decremental conduction in PVs was more frequent ( 93 % versus 56 % , P = 0.01 ) and had a greater increment ( 102±65 versus 42±40 ms , P < 0.001 ) in patients with AF . Finally , AF was more frequently induced when pacing was performed in PVs ( 22 of 90 ) versus LA ( 1 of 81 ) in patients with AF ( P < 0.001 ) . Conclusions —The PVs of patients with AF exhibited distinctive electrophysiological properties , which were strikingly different from those of patients devoid of AF , potentially explaining their arrhythmogenicity
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 .