Circumferential Pulmonary-Vein Ablation for Chronic Atrial Fibrillation

doi:10.1056/NEJMoa050955

Volume 354:934-941		March 2, 2006		Number 9

Circumferential Pulmonary-Vein Ablation for Chronic Atrial Fibrillation

Hakan Oral, M.D., Carlo Pappone, M.D., Aman Chugh, M.D., Eric Good, D.O., Frank Bogun, M.D., Frank Pelosi, Jr., M.D., Eric R. Bates, M.D., Michael H. Lehmann, M.D., Gabriele Vicedomini, M.D., Giuseppe Augello, M.D., Eustachio Agricola, M.D., Simone Sala, M.D., Vincenzo Santinelli, M.D., and Fred Morady, M.D.

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by Wood, M. A.

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ABSTRACT

Background We conducted a randomized, controlled trial of circumferentialpulmonary-vein ablation for the treatment of chronic atrialfibrillation.

Methods A total of 146 patients with a mean (±SD) ageof 57±9 years who had chronic atrial fibrillation wererandomly assigned to receive amiodarone and undergo two cardioversionsduring the first three months alone (the control group) or incombination with circumferential pulmonary-vein ablation. Cardiacrhythm was assessed with daily telephonic transmissions forone year. The left atrial diameter and the severity of symptomswere assessed at 12 months.

Results Among the 77 patients assigned to undergo circumferentialpulmonary-vein ablation, ablation was repeated because of recurrentatrial fibrillation in 26 percent of patients and atypical atrialflutter in 6 percent. An intention-to-treat analysis showedthat 74 percent of patients in the ablation group and 58 percentof those in the control group were free of recurrent atrialfibrillation or flutter without antiarrhythmic-drug therapyat one year (P=0.05). Among the 69 patients in the control group,53 (77 percent) crossed over to undergo circumferential pulmonary-veinablation for recurrent atrial fibrillation by one year and only3 (4 percent) were in sinus rhythm without antiarrhythmic-drugtherapy or ablation. There were significant decreases in theleft atrial diameter (12±11 percent, P<0.001) andthe symptom severity score (59±21 percent, P<0.001)among patients who remained in sinus rhythm after circumferentialpulmonary-vein ablation. Except for atypical atrial flutter,there were no complications attributable to circumferentialpulmonary-vein ablation.

Conclusions Sinus rhythm can be maintained long term in themajority of patients with chronic atrial fibrillation by meansof circumferential pulmonary-vein ablation independently ofthe effects of antiarrhythmic-drug therapy, cardioversion, orboth. The maintenance of sinus rhythm is associated with a significantdecrease in both the severity of symptoms and the left atrialdiameter.

Source Information

From the Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (H.O., A.C., E.G., F.B., F.P., E.R.B., M.H.L., F.M.); and the Electrophysiology and Cardiac Pacing Department, San Raffaele University Hospital, Milan (C.P., G.V., G.A., E.A., S.S., V.S.).

Drs. Oral and Pappone and Drs. Santinelli and Morady contributed equally to the article as first authors and senior authors, respectively.

Address reprint requests to Dr. Oral at the Division of Cardiovascular Medicine, TCB1 140 D, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0311, or at oralh{at}umich.edu.

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Circumferential Pulmonary-Vein Ablation for Atrial Fibrillation
Wazni O. M., Fahmy T. S., Natale A., Aberegg S. K., Majure D., Auer J., Lamm G., Eber B., Oral H., Pappone C., Morady F., Wood M. A., Ellenbogen K. A.
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N Engl J Med 2006; 354:2289-2291, May 25, 2006. Correspondence

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