Introduction: Ablative therapy for atrial fibrillation (AF) by targeting in
itiating triggers, usually in or around the pulmonary veins, has been repor
ted by several centers. Evidence for an overall improvement in quality of l
ife (QOL) and amelioration of symptoms is lacking.
Methods and Results: Seventy-one patients undergoing attempted ablation of
focal AF were followed for 60 +/- 33 weeks. QOL and symptom questionnaires
were completed 1 month before and 6 months after electrophysiologic study.
Twenty-three patients (32%) underwent electrophysiologic mapping but no abl
ation because of either insufficient or multifocal ectopy; the other 48 pat
ients (68%) underwent attempted ablation. Sixteen of 48 patients (33%) unde
rgoing ablation, or 16 (23%) of 71 on an intention-to-treat basis, were fou
nd at last follow-up to have persistent sinus rhythm without antiarrhythmic
drugs. Patients who underwent mapping without ablation reported no improve
ments in any QOL or symptom score, whereas patients who had long-term succe
ssful ablation had significant improvements in all six QOL measures. Intere
stingly, patients who developed AF recurrence after ablation still reported
significant improvements in 4 of 6 QOL measures. Four of 48 patients (8.3%
) undergoing ablation developed pulmonary vein stenosis.
Conclusion: Paroxysmal AF can be treated successfully in some patients by a
blating initiating triggers in the pulmonary veins; however, in our experie
nce the recurrence rate (32/48 [68%]) and risk of pulmonary vein stenosis (
8%) after ablation are high. Patients with recurrent AF after ablation of f
ocal AF triggers have significant improvement in QOL and symptoms compared
with before ablation. Patients and their physicians should carefully balanc
e the risks and benefits before considering ablation.