Pulmonary vein isolation for persistent atrial fibrillation. Long-term results

Pulmonary vein isolation has been employed to eliminate paroxysmal atrial fibrillation. However, the long-term outcome in terms of long-standing persistent atrial fibrillation is unclear.

One hundred patients with rheumatic mitral valve disease and long-standing (>1 year) persistent atrial fibrillation were operated on between July 1998 and June 2007. Mitral valve surgery and surgical isolation (cut-and-sew) of the pulmonary veins were performed in all cases. Transthoracic echocardiography and 24-h Holter monitoring were obtained after 3 and 6 months and yearly thereafter.

Early and late follow-up was 99% and 92% complete, respectively. The endpoint was freedom from atrial fibrillation. There was one (1%) hospital death. Atrial fibrillation was present in 39%, 47%, 63% and 68% of patients at 3 months, 1 year, 3 years, and 5 years after surgery, respectively. The odds ratios for recurrence of atrial fibrillation postoperatively were 1.41 (95% confidence interval 1.14-1.74), 2.17 (95% confidence interval 1.63-2.90), and 3.62 (95% confidence interval 2.44-5.38) at 1 week, 3 years, and 5 years, respectively. Actuarial freedom from atrial fibrillation was 35% at 3 years, and 30% at 5 years. A direct relationship was observed between preoperative left atrial size >6 cm and atrial fibrillation recurrence at 5 years (p < 0.05 odds ratio = 2.5, 95% confidence interval 1.15 - 5.4).

No beneficial effects of simple pulmonary vein isolation for long-standing persistent atrial fibrillation concomitant with rheumatic mitral valve disease were observed. Atrial fibrillation cannot be fully treated using only pulmonary vein isolation.