OBJECTIVETo compare two catheter ablation strategies for pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (PAF).

METHODSFifty consecutive patients who underwent PV isolation by circumferential PV ablation (CPVA group) were compared with 50 consecutive patients who underwent PV isolation by segmental PV ablation (SPVA group). The enrolled subjects in this retrospective study were patients with frequent attacks (more than 3 times per month) and symptomatic PAF. Procedure-related parameters, safety and clinical outcome within 6 months after procedures for the 2 strategies were analyzed.

RESULTSThe characteristics and mean procedure time were comparable between the 2 groups. The mean fluoroscopy time and mean ablation time were 57 min +/- 11 min and 42 min +/- 9 min in the SPVA group and 31 min +/- 8 min and 61 min +/- 13 min in the CPVA group (both P < 0.01), respectively. After the first procedure, symptomatic atrial tachyarrhythmias (ATa) recurred in 24 (48%) of 50 patients who underwent SPVA and 15 (30%) of 50 patients who underwent CPVA within 3 months (P = 0.10). During 6 months of follow-up, 82% of patients with CPVA and 60% of patients with SPVA were free of symptomatic ATa without any antiarrhythmic drugs for at least 3 months (P < 0.05). One patient per each group developed asymptomatic right superior PV stenosis.

CONCLUSIONIn patients with PAF, CPVA compares favorably with SPVA, but either of them yields a similar clinical safety.