Background: Pulmonary vein isolation (PVI) has become an accepted therapy for patients with atrial fibrillation (AF) and the indications have widened to include non-paroxysmal AF-patients. Clinical and echocardiographic parameters should help to identify patients who have the best long-term benefit from PVI.
Methods and Results: After baseline clinical and echocardiographic evaluation the follow-up strategy in the first year and thereafter, if non-sustained AF has been recorded included: 1) Clinical follow up, 12-lead ECG and 24-h ECG every 3 months, 2) trans-telephonic ECGs twice daily and when symptomatic (over 4 weeks) every 3 months, or 3) continuous monitoring via implanted devices. A recurrence was an atrial arrhythmia lasting >30sec. All 340 PVI procedures of 229 consecutive patients were analyzed. On average, 1.5 PVI procedures per patient (range, 1-6 PVI) were performed. The mean age was 58 ± 11 years (73% male) with 109 paroxysmal and 120 non-paroxysmal AF cases. Clinical follow-up with 12-lead ECGs, 24-h ECGs, trans-telephonic ECGs and implanted devices was available in 100%, 63%, 51% and 16% of cases, respectively. The one-year recurrence rate of 59% (range, 24% - 82%) was dependent on grades of diastolic function (normal - dysfunction grade III) in a multivariate analysis model. Patients with normal diastolic function had the lowest recurrence rates of 24% and 49% after 1 and 3 years of follow-up, respectively (p<.0001).
Conclusions: PVI in unselected AF-patients is a palliative strategy with high recurrence rates obtained by close monitoring. Grading of diastolic function can identify AF-patients who benefit most from PVI.