This study was supported by a research grant from CardioFocus, Inc., Marlborough, MA, USA.
Acute and Long-Term Clinical Outcome After Endoscopic Pulmonary Vein Isolation: Results from the First Prospective, Multicenter Study
Version of Record online: 11 SEP 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 1, pages 7–13, January 2013
How to Cite
METZNER, A., WISSNER, E., SCHMIDT, B., CHUN, J., HINDRICKS, G., PIORKOWSKI, C., OUYANG, F. and KUCK, K.-H. (2013), Acute and Long-Term Clinical Outcome After Endoscopic Pulmonary Vein Isolation: Results from the First Prospective, Multicenter Study. Journal of Cardiovascular Electrophysiology, 24: 7–13. doi: 10.1111/j.1540-8167.2012.02427.x
Disclosures: K.-H. Kuck: CardioFocus: research grant, speaker's honoraria, consultant. C. Piorkowski: St. Jude Medical: research grant, honoraria, consultant; Siemens: research grant, honoraria, consultant; Biotronik: research grant, honoraria. A. Metzner, E. Wissner, B. Schmidt, and K.R.J. Chun: CardioFocus: speaker's honoraria.
- Issue online: 2 JAN 2013
- Version of Record online: 11 SEP 2012
- Accepted manuscript online: 31 JUL 2012 12:26PM EST
- Manuscript received 22 May 2012; Revised manuscript received 5 July 2012; Accepted for publication 9 July 2012.
- atrial fibrillation;
- catheter ablation;
- endoscopic balloon;
- pericardial tamponade;
- pulmonary vein isolation
Clinical Outcome After Endoscopic PVI. Introduction: The acute and long-term outcome of pulmonary vein isolation (PVI) using an endoscopic ablation system (EAS) has only been reported in single-center studies. The current prospective, multicenter study assessed the acute and 1-year outcome following PVI using the EAS.
Methods and Results: Seventy-two patients (34 female, mean age 58 ± 10 years) with a history (5 ± 6 years) of drug-refractory paroxysmal atrial fibrillation (AF) were included. Endoscopic PVI was performed in all patients. Follow-up was based on regular telephone interviews, Holter ECG, and transtelephonic ECG recordings. Recurrence was defined as a symptomatic and/or documented AF episode >30 seconds following a blanking period of 3 months. In 72 patients, a total of 281 pulmonary veins (PVs) were targeted and 277/281 (98.6%) PVs were isolated successfully using only the EAS. PV stenosis, thrombembolic events, pericardial effusion, pericardial tamponade, and phrenic nerve palsy occurred in 0 of 72, 0 of 72, 3 of 72 (4.2%), 4 of 72 (5.6%), and in 1 of 72 (1.4%) patients, respectively. Sixty-seven of 72 (93.1%) patients completed a follow-up of 365 days and 42 of 67 (62.7%) patients remained in stable sinus rhythm after a single procedure. A total of 13 of 25 (52%) patients suffering from AF recurrence consented to repeat PVI using conventional radiofrequency energy 221 ± 121 days after the index procedure. LA to PV reconduction was found in 30 of 45 (67%) previously isolated PVs.
Conclusions: A very high rate of acute electrical PVI is achieved using exclusively the EAS. The 1-year single-procedure success rate in patients with paroxysmal AF is comparable to conventional PVI. PV reconduction is the major determinant for AF recurrence. (J Cardiovasc Electrophysiol, Vol. 24, pp. 7-13, January 2013)