Arrhythmias & electrophysiologyResearch article
20 Years
- 20-year outcomes of pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF)
Authors' conclusion
During 20 years post-PVI, 25% of patients maintained stable sinus rhythm, including multiple ablation procedures and antiarrhythmic drugs. Despite being at risk for stroke, half of the patients were off anticoagulation, with the majority being "PVI responders" in stable sinus rhythm. The low stroke rate during long-term follow-up may indicate a potential beneficial effect of PVI; however, confirmation in larger studies is necessary.
Study context
- Population
- Patients with symptomatic, drug-refractory PAF who underwent PVI with radiofrequency current, confirmed by the double-lasso technique, from 2003 to 2004median follow-up 19.3 years
- Participants
- 154 patients
Main finding
As reported in the abstract
Multiple procedural success
25%
Ablation procedures
2 ± 1
Patients on antiarrhythmic drugs
24%
Further findings
Progression from PAF to persistent atrial fibrillation
- Progression rate
- 13% (n = 20 of 154)
PVI durability in very late AT recurrences
- PVI durability
- 83%
Oral anticoagulation discontinuation · last follow-up
- Oral anticoagulation discontinued
- 48% (n = 75 of 154)
- Of those who discontinued, in stable sinus rhythm
- 73% (n = 55 of 75)
Baseline characteristics and follow-up
- Median age
- 76 years [Q1-Q3: 66-83 years]
- Female
- 26%
- Median follow-up
- 19.3 years (Q1-Q3: 15.9 years to not available)
Safety
Long-term cardiovascular outcomes and deaths · 20 years
- Thromboembolic events
- 7 (4.5%)
- Cardiopulmonary resuscitations
- 3 (1.9%)
- Acute coronary syndromes
- 3 (1.9%)
- Major bleeding
- 1 (0.6%)
- Deaths
- 19 (12%)
- Causes of death
- 42% cancer, 26% unknown, 16% cardiovascular
Original publication
Summarised from the published abstract; every number is checked against it