Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity-matched analysis.

Abstract

The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV-Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV-Comp isolation is an alternative strategy for persistent AF ablation. Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n=100; PV-Comp isolation, n=100) were selected by propensity score matching. Both groups were followed up for 1 year. At 6- and 12-month follow-up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P=.006) and 33 patients (P<.001) in PV-Comp isolation group, respectively. PV-Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV-Comp isolation: 10 months, log-rank P<.001) and a lower probability of recurrence (odds ratio [OR]=0.32; 95% confidence of interval [CI]=0.18-0.56, P<.001), with no increase in procedural complications (PVI: 5 of 100, PV-Comp isolation: 6 of 100, P=.76). Procedure duration was longer in PV-Comp isolation group (PVI: 186 ± 42min, PV-Comp isolation: 238 ± 44min, P<.001), as well as fluoroscopy time (PVI: 22 ± 16min, PV-Comp isolation: 31 ± 21min, P=.001). PV-Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications.