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 .
Efficacy and safety of segmental ostial versus circumferential extra-ostial pulmonary vein isolation for atrial fibrillation.
INTRODUCTION Pulmonary vein ( PV ) isolation for atrial fibrillation ( AF ) can be performed using a segmental ostial or a circumferential extra-ostial approach . The relative merits and potential limitations of each approach are currently debated . Here we report our early experience with each of these approaches , including their relative efficacy and safety . METHODS AND RESULTS Forty patients with drug-refractory AF underwent segmental ostial PV isolation and were compared to 40 consecutive patients who underwent PV isolation using a circumferential extra-ostial approach . The latter approach described here is novel in two aspects : ( 1 ) the endpoint for ablation was PV isolation and not only delay in left atrial to PV conduction time , and ( 2 ) isolation of the right and left PVs was achieved by a single encirclement of ipsilateral veins . At follow-up , 60 % of the patients in the segmental group were free of AF compared to 75 % of the patients in the circumferential group . There was one thromboembolic cerebrovascular complication during the ablation procedure in each group . CONCLUSION PV isolation using a circumferential extra-ostial approach , where the ipsilateral PVs are isolated together by one encircling line of block using electroanatomic mapping , is a technically feasible procedure . This approach is at least as effective and safe as the more established segmental ostial approach for AF ablation
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 .