Is selective ipsilateral PV isolation sufficient for focally triggered paroxysmal atrial fibrillation? Comparison of selective ipsilateral pulmonary vein isolation versus bilateral pulmonary vein isolation.

Introduction: Selective ipsilateral pulmonary vein isolation (SIPVI) has shown comparable efficacy in focal triggered atrial fibrillation (AF) versus isolation of all pulmonary veins (PVs), yet the sufficiency for such an ablation strategy to all patients is unclear. This study sought to identify a subgroup of patients for SIPVI and a subgroup of patients for bilateral PV isolation (BiPVI) with long-term success by comparing the clinical efficacy of SIPVI and BiPVI on PV-triggered AF.

Methods And Results: One hundred and forty-two patients (106 males; mean age 51 ± 13 years) with focal PV triggered paroxysmal AF (PAF) were studied. Seventy patients underwent SIPVI and 72 patients underwent BiPVI. After the first ablation, 44 patients (44/70) in the SIPVI group and 54 patients (54/72) in the BiPVI group were free of AF without antiarrhythmic drugs, after a follow-up period of 36 ± 12 months (log-rank test P = 0.1594). In patients younger than 50 years of age with a left atrium (LA) diameter <40 mm, SIPVI had a high success rate (15/18, 83%) of freedom from AF. However, for patients aged ≥50 years with an LA diameter ≥40 mm, 10 of the 12 patients in the SIPVI group and only 5 of the 15 patients in the BiPVI group had a recurrence of AF (log-rank test P = 0.0173).

Conclusions: For focally triggered PAF, in patients aged <50 years with an LA diameter <40 mm, SIPVI of triggering PV had a high success rate of freedom from AF. However, in patients aged ≥50 years with an LA diameter ≥40 mm, BiPVI achieved a higher success rate.