One-year clinical outcome after pulmonary vein isolation using the novel endoscopic ablation system in patients with paroxysmal atrial fibrillation

BACKGROUND Pulmonary vein isolation (PVI) is an established treatment option for atrial fibrillation (AF). Recently the novel endoscopic ablation system (EAS) was introduced and proved potential for successful acute PVI. OBJECTIVE This study sought to investigate the 1-year follow-up results after EAS-based PVI. METHODS A total of 40 patients (20 female, age 57 +/- 9 years) with a long history (5 +/- 4 years) of drug-refractory (2 +/- 1 antiarrhythmic drugs) paroxysmal AF were included into our analysis. PVI was performed using exclusively the novel EAS. Follow-up included regular telephonic interviews, Holter electrocardiographic (ECG) and transtelephonic ECG recordings. A symptomatic or documented AF episode > 60 seconds after a blanking period of 3 months was defined as recurrence. RESULTS A total of 155 PVs were targeted; 153 of 155 (99%) PVs were isolated successfully using exclusively the novel EAS. During a median follow-up of 402 (331 to 478; quartile 1 to quartile 3) days, 24 of 40 patients (60%) remained free of any symptomatic or documented AF episode without antiarrhythmic drugs after a single procedure. Seven patients suffering from AF recurrence underwent radiofrequency current-based Re-PVI 203 +/- 102 days after the index EAS-based procedure. Left atrium to pulmonary vein reconduction was found in 17 of 25 initially isolated PVs. No PV stenosis was detected based on magnetic resonance imaging 3 months postablation. CONCLUSION Patients after EAS-based PVI due to paroxysmal AF demonstrate 1-year single-procedure success rates similar to those of other ablation techniques and ablation energies. The major determinant for AF recurrence after EAS treatment seems to be reconnection of previously isolated PVs. More patients and longer follow-up periods are mandatory before final conclusions can be drawn regarding the efficacy and safety of the EAS.