Comparison of the Efficacy of Empiric Thoracic Vein Isolation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation in Patients Without Structural Heart Disease

J Cardiovasc Electrophysiol. 2017 Mar;28(3):266-272. doi: 10.1111/jce.13159. Epub 2017 Jan 25.


Introduction: The guidelines suggest that an adjuvant substrate modification in addition to pulmonary vein isolation (PVI) may be needed for persistent atrial fibrillation (PerAF) assuming that catheter ablation is less successful for PerAF than paroxysmal AF (PAF). To revisit the above assumption, we compared the outcome of the same catheter ablation strategy between PAF and PerAF.

Methods and results: Two hundred and thirty-three consecutive patients (mean age 60 ± 10 years, 53 PerAF and 8 long-lasting PerAF) without structural heart disease underwent catheter ablation of AF by the same strategy using an empiric thoracic vein isolation (a wide circumferential PVI plus empiric superior vena cava isolation) as a major part of the strategy without any adjuvant substrate modification. The duration of AF in the patients with PerAF was 6 ± 4 months. During 25 ± 10 months of follow-up after single procedures, 71 (30%) patients had atrial tachyarrhythmia recurrences without antiarrhythmic drugs. A Kaplan-Meier analysis of the recurrence-free survival rate after a single procedure and after repeat procedures revealed no significant difference between the patients with PAF and those with PerAF (log-rank, P = 0.38 and P = 0.27, respectively). A Cox regression multivariate analysis of the variables including the age, gender, PerAF, body mass index, left ventricular ejection fraction, and left atrial volume index demonstrated that none of the variables were an independent predictor of an atrial tachyarrhythmia recurrence after a single ablation procedure.

Conclusion: In patients without underlying heart disease, the procedural outcome of an empiric thoracic vein isolation is comparable for PAF and PerAF.

Keywords: atrial fibrillation; catheter ablation; paroxysmal atrial fibrillation; persistent atrial fibrillation; pulmonary vein isolation; superior vena cava isolation; thoracic vein isolation.

Publication types

  • Comparative Study

MeSH terms

  • Action Potentials
  • Aged
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Catheter Ablation* / adverse effects
  • Comparative Effectiveness Research
  • Disease-Free Survival
  • Female
  • Heart Rate
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications / etiology
  • Proportional Hazards Models
  • Prospective Studies
  • Pulmonary Veins / physiopathology
  • Pulmonary Veins / surgery*
  • Recurrence
  • Reoperation
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vena Cava, Superior / physiopathology
  • Vena Cava, Superior / surgery*