Factors predicting success of circumferential PVI
GHENT, BELGIUM. The success rate for a single pulmonary vein isolation procedure carried out at a top-rated center now ranges between 70% and 90% in the case of healthy, paroxysmal afibbers. Researchers at University Hospital Ghent recently carried out a study to determine if there were any specific pre-procedure variables that could predict, more specifically, whether a PVI would be successful.
Their study involved 100 patients (average age of 54 years), 85% of whom were lone afibbers with paroxysmal (80%), or short-standing persistent (20%) afib. The patients had an average of 4 symptomatic episodes a week and had been diagnosed an average of 6.2 years ago. They had unsuccessfully tried an average of 2.6 antiarrhythmic drugs each. All participants underwent a circumferential PVI (CARTO-guided) procedure while in sinus rhythm. They remained on antiarrhythmics (sotalol or flecainide) and warfarin for at least 3 months following the procedure.
After an average follow-up of 28 months (15 – 59 months) Holter monitoring was performed. At this time, 71% of patients were free of afib without the use of antiarrhythmic drugs, while 5% experienced recurring asymptomatic episodes. An early occurrence (during the first month following the procedure) was not necessarily an indication of failure since 17 out of 25 patients (68%) experiencing recurrence were afib-free at the end of follow-up. The researchers found no evidence that age and gender influenced the outcome of the procedure; however, they did notice that patients who were ablated early in their "afib career" experienced a substantially better outcome (92% success if ablated within 1 year of diagnosis) than did those who waited. The researchers also found that a smaller left atrial volume (measured by 3D CARTO geometry) was associated with a substantially greater success. Thus, patients with a LA volume less than 80 mL had a success rate of 88% at end of follow-up, while those whose procedures failed had an average LA volume of 106 mL.
De Potter, T, et al. Predictors of success after a first circumferential pulmonary vein isolation for atrial fibrillation. Journal of Atrial Fibrillation, Vol. 1, No. 6, April 2009, pp. 311-20
Editor's comment: The above findings provide strong evidence that undergoing an ablation soon after diagnosis materially improves the chance of success. However, a decision to "jump right in" must be weighed against the currently unknown long-term effects of PVIs in general.
Their study involved 100 patients (average age of 54 years), 85% of whom were lone afibbers with paroxysmal (80%), or short-standing persistent (20%) afib. The patients had an average of 4 symptomatic episodes a week and had been diagnosed an average of 6.2 years ago. They had unsuccessfully tried an average of 2.6 antiarrhythmic drugs each. All participants underwent a circumferential PVI (CARTO-guided) procedure while in sinus rhythm. They remained on antiarrhythmics (sotalol or flecainide) and warfarin for at least 3 months following the procedure.
After an average follow-up of 28 months (15 – 59 months) Holter monitoring was performed. At this time, 71% of patients were free of afib without the use of antiarrhythmic drugs, while 5% experienced recurring asymptomatic episodes. An early occurrence (during the first month following the procedure) was not necessarily an indication of failure since 17 out of 25 patients (68%) experiencing recurrence were afib-free at the end of follow-up. The researchers found no evidence that age and gender influenced the outcome of the procedure; however, they did notice that patients who were ablated early in their "afib career" experienced a substantially better outcome (92% success if ablated within 1 year of diagnosis) than did those who waited. The researchers also found that a smaller left atrial volume (measured by 3D CARTO geometry) was associated with a substantially greater success. Thus, patients with a LA volume less than 80 mL had a success rate of 88% at end of follow-up, while those whose procedures failed had an average LA volume of 106 mL.
De Potter, T, et al. Predictors of success after a first circumferential pulmonary vein isolation for atrial fibrillation. Journal of Atrial Fibrillation, Vol. 1, No. 6, April 2009, pp. 311-20
Editor's comment: The above findings provide strong evidence that undergoing an ablation soon after diagnosis materially improves the chance of success. However, a decision to "jump right in" must be weighed against the currently unknown long-term effects of PVIs in general.
The AFIB Report, Forum and Database do not provide medical advice. Do not attempt self-diagnosis or self-treatment based on our reports.
Donate Today!
Please donate to The AFIB Report, using one of the two buttons below.
A third donation method, beyond choosing either the Donate with PayPal or Donate with Credit/Debit card described elsewhere on this site, is for those who prefer to directly mail a check or money order to our business address at: The AFIB Report, A Non-Profit 501(c)(3) Corporation, C/O Shannon Dickson, P.O. Box 1016, Sedona, Arizona 86339. Any of the three donation options are fine with us based on each donor's preference, and with our sincere gratitude!
A third donation method, beyond choosing either the Donate with PayPal or Donate with Credit/Debit card described elsewhere on this site, is for those who prefer to directly mail a check or money order to our business address at: The AFIB Report, A Non-Profit 501(c)(3) Corporation, C/O Shannon Dickson, P.O. Box 1016, Sedona, Arizona 86339. Any of the three donation options are fine with us based on each donor's preference, and with our sincere gratitude!
The AFIB Report, A Non-Profit Tax-Exempt 501(c)(3) Corporation
Learn