Cardiac Rhythm Disorders

Pulmonary Vein Antrum Isolation Procedures

Volume

2013 - 2017

Pulmonary vein antrum isolation (PVAI) essentially disconnects the pathway of the abnormal heart rhythm and prevents atrial fibrillation.

Success Rates for Pulmonary Vein Antrum Isolation

Success of pulmonary vein antrum isolation (PVAI) is defined as a restored sinus rhythm without recurrence of atrial fibrillation (AF) after the patient has stopped taking antiarrhythmic medications for at least 12 months after the procedure. This is influenced by a number of factors, including the length of time the patient has been in AF and the presence or absence of underlying heart disease.

In a recent study¹ of 831 patients who underwent PVAI at Cleveland Clinic, 81% of patients with paroxysmal AF were arrhythmia-free while off antiarrhythmic drugs at 12 months postablation. Paroxysmal AF is defined as AF that terminates within days without cardioversion. A total of only 7.8% of this patient population had AF after 1 year postablation (late-recurrence AF).

The success rate is lower for patients with persistent or long-standing persistent AF (65% for a single ablation procedure) and is affected by the presence of valvular heart disease or other underlying problems.

A total of 161 patients who had early recurrence of AF had a repeat ablation procedure. At 14 months after repeat ablation, 78.9% were arrhythmia-free while off antiarrhythmic drugs. Of the 27 patients who had late-recurrence AF and a repeat ablation, 74.1% were arrhythmia-free while off antiarrhythmic drugs at 17 months after repeat ablation.

Reference

  1. Hussein AA, Saliba WI, Martin DO, Bhargava M, Sherman M, Magnelli-Reyes C, Chamsi-Pasha M, John S, Williams-Adrews M, Baranowski B, Dresing T, Callahan T, Kanj M, Tchou P, Lindsay BD, Natale A, Wazni O. Natural history and long-term outcomes of ablated atrial fibrillation. Circ Arrhythm Electrophysiol. 2011 Jun;4(3):271-278.
Complications of Pulmonary Vein Antrum Isolation

2017

The overall riskᵃ associated with pulmonary vein antrum isolation at Cleveland Clinic in 2017 was 1.25%, which is lower than the benchmark rate of 4.5%.

Complication N Percent Benchmark Rate (%) (1)
Total 12 1.25 4.5
Death 1 0.1 0.15
Tamponade 8 0.83 1.31
Pneumothorax 0 0.00 0.09
Hemothorax 0 0.00 0.02
Sepsis, abscesses, endocarditis 0 0.00 0.01
Permanent diaphragmatic paralysis 1 0.00 0.17
Total femoral pseudoaneurysm 1 0.1 0.93
Total arteriovenous fistula 0 0.00 0.54
Valve damage/requiring surgery 0 0.00 0.07
Atrioesophageal fistula 0 0.00 0.04
Stroke 0 0.00 0.23
Transient ischemic attack 0 0.00 0.71
Pulmonary vein stenosis requiring intervention 1 0.1 0.29

ᵃThe percentage of overall risk was calculated by dividing the total number of complications (N = 12) by the total number of PVAI procedures (N = 960).

References:

  1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010 Feb;3(1):32-38.