Stepwise ablation in treatment of atrial fibrillation based on circumferential pulmonary vein ablation

Objective To investigate the feasibility and efficacy of a stepwise ablation procedure in treatment of atrial fibrillation(AF) on the basis of circumferential pulmonary vein(PV) ablation guided by a three-dimensional mapping system(Carto).Methods Twelve patients with drug-refractory paroxysmal(n=10) and persistent(n=2) atrial fibrillation were subjected to three-ablation stages during one session: circumferential ablation around the pulmonary vein antrum,segmental pulmonary vein ablation,and ablation of complex fractionated atrial electrograms(CFAEs).Endpoint of the procedure was a non-inducibility of AF at any stage or completion of all three-ablation stages.Results Ten patients with a paroxysmal AF had a non-inducible AF at the end of the procedure: seven patients after the first stage,two after the second and one after the third.Two patients with a persistent AF who remained AF after all stages required an external cardioversion.Three patients had a recurrent AF within two days,but were free of recurrent AF after further follow-up.One patient with a paroxysmal AF and typical atrial flluter(AFL) had a recurrent AFL and was free of recurrent AF.During 10±4 months of follow-up,all patients were free of recurrent AF or had left atrial arrhythmias without an anti-arrhythmic drug therapy,and no complications occurred.Average radiofrequency energy delivery,fluoroscopy time and procedure time were(38±11) min,(37±11) min and(3.0±0.5) h,respectively.Conclusion A stepwise ablation procedure on the basis of circumferential pulmonary vein ablation with the AF noninducibilty as a endpoint iseffective and safe.Circumferential pulmonary vein ablation alone is enough for paroxysmal AF treatment,while it combined with segmental pulmonary vein ablation and CFAEs ablation may result in high successful rates.