XML Template (2015) [1.4.2015–10:59am] [1–5] //blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/AANJ/Vol00000/150044/APPFile/SG-AANJ150044.3d (AAN) [PREPRINTER stage] Original Article

Pulmonary vein isolation for persistent atrial fibrillation. Long-term results Ovidio A Garcia-Villarreal Background: 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. Methods: 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. Results: 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). Conclusions: 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