Pulmonary vein isolation during minimally invasive mitral valve surgery: one-year follow-up

Abstract

geted for PV isolation. Circumferential PV electrogrems around the PV ostium were acquired simultaneously using a circular catheter and used to guide ablation at ostial sites with the earliest PV potentials during sinus rhythm or coronary sinus pacing. Radiofrequency ablation was performed at 50 C and 20-30 W, The endpoint was the elimination of either AF (42 patients) or atrio-PV conduction based on the abolition of distal PV potentials (38 patients). Results: Focal ablation, PV isolation or both were performed in 42, 19 and 19 patients, respectively. Of the 104 foci identified, 94 triggers (90%) originated from the PV single in 47% and multiple in 53% and 10 originated from the atrial tissue. AF recurred in 42 patients and re-ablation was performed in 24:7 from the same source, 3 from non-PV foci, 2 from a different part of the same PV, 2 from a different PV, 2 from PV ostia proximal to the previous PV isolation, and 8 due to recovery of atrio-PV conduction. During a mean follow-up of 14 ± 9 months, the clinical success rate with combined therapy (69%) was significantly higher than those with focal ablation (57%) or PV isolation (53%) without drugs (p < 0.05). No PV stenosis was observed. Conclusions: Focal ablation did not prevent AF by another focus in the same PV or other PVs. The success rate of PV isolation is relatively low, probably due to unmasked foci from the PV ostial edge or atrial tissue. Combined treatment with focal ablation and PV isolation is more effective for treating AF than either approach alone.