Large radiofrequency ablation lesions can be created with a retractable infusion-needle catheter

BACKGROUND: Radiofrequency (RF) catheter ablation of ventricular tachycardia is sometimes limited by inadequate lesion depth. We report the use of a novel retractable needle-tipped electrode catheter with intramyocardial (IM) saline infusion and IM RF energy delivery to create large myocardial ablation lesions. METHODS: The left ventricle was entered via the femoral artery in 6 and 11 anesthetized goats and swine (32-90 kg) with an 8-F electrode catheter with an extendable 27-gauge needle at the tip (modified for RF ablation by making the needle electrically active). The needle was advanced 5-7 mm intramyocardially and 0.9% saline was infused 1 mL/min x 60 seconds prior to, and throughout a 120-second application of RF via the active needle, with power titrated to 12 W for 9 lesions, and 30-40 W for 37 lesions, followed by a 120-second RF application using the 4-mm-tip electrode, with power titrated to achieve a 10-Omega decrease in impedance. Needle/saline lesions were compared to 18 standard 4-mm-tip control lesions (power titrated to < or =50 W, to achieve a 10-Omega impedance decrease or limited to 60 degrees Celsius) and to 17 irrigated 3.5-mm-tip lesions (power titrated to < or =50 W, temperature limited to 50 degrees Celsius, 30 mL/min infusion rate). Lesions were identified in the excised heart, fixed, serially sectioned from the endocardium, and digitally analyzed to calculate volume. RESULTS: Lesions were homogeneous and had distinct borders. Compared to 4-mm-tip and irrigated-tip lesions, high-power needle/saline lesions were significantly deeper (13 +/- 2 vs 5 +/- 1 and 8 +/- 3 mm, P < 0.001), had significantly larger volumes (1,700 +/- 750 vs 240 +/- 170 and 750 +/- 650 mm(3), P < 0.001), and had larger cross-sectional area at each millimeter depth beyond the 1 mm (P < 0.01). CONCLUSIONS: IM saline infusion and IM RF energy delivery markedly increase RF lesion size as compared to standard RF ablation and is feasible with a percutaneous catheter. This method warrants further investigation because of its potential clinical utility.     

点消融和线性消融治疗典型心房扑动的对比研究

目的:采用点消融三尖瓣峡部的方法治疗典型心房扑动,并对比常规线性消融,证实点消融治疗典型心房扑动的可行性。方法:14例典型心房扑动病人分为线性消融组(A组)与点消融组(B组),分别比较2组下腔静脉与三尖瓣峡部双向阻滞的手术时间、X线照射时间、放电次数、手术费用、复发率。结果:点消融组病人的手术时间、X线照射时间短,放电次数少,手术费用低(P<0．01),2组均无心包填塞、三度房室传导阻滞以及栓塞等并发症,复发率没有统计学差异。结论:点消融是一种值得进一步推广的治疗典型心房扑动的方法。     

Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison.

AIMS: To investigate the effectiveness of additional substrate modification (SM) by left atrial (LA) linear lesions as compared with pulmonary vein isolation (PVI) alone in patients with persistent atrial fibrillation (AF) in a prospective randomized study. Percutaneous PVI has evolved as an accepted treatment for paroxysmal AF but seemed to be less effective in patients with persistent AF. The benefit of PVI alone and additional linear lesions has not been validated in a randomized study so far. METHODS AND RESULTS: Sixty-two patients with persistent AF (median duration 7, range 1-18 months) were randomly assigned to either PVI alone (n = 30) or additional SM (n =32) consisting of a roof line connecting both left superior and right superior PV and LA isthmus ablation between left inferior PV and mitral annulus. Procedures including SM were performed using a three-dimensional mapping system (EnSite NavX, St Jude Medical, St Paul, MN, USA). Anti-arrhythmic drugs were discontinued within 8 weeks after ablation in both groups. Follow-up included daily trans-telephonic ECG transmitted irrespective of the patient's symptoms. PVI was successful in 98% of all targeted veins in both groups. Additional SM did not increase fluoroscopy time (72.1+/-18.7 vs. 72.9+/-17.3 min, P=0.92) because of the use of three-dimensional navigation in the PVI+SM group. AF recurrences within the first 4 weeks following ablation were more common after PVI alone (77%) than additional SM (44%, P=0.002). After a follow-up time of 487 (429-570) days, only 20% of patients undergoing stand alone PVI remained in sinus rhythm when compared with 69% following PVI combined with SM (P=0.0001). Two patients assigned to PVI+SM experienced procedure-related complications (cardiac tamponade and minor stroke) which resolved without sequelae. CONCLUSION: PVI alone is insufficient in the treatment of persistent AF. However, additional left linear lesions increase the success rate significantly. Early AF-relapses are associated with a negative outcome after PVI alone but not following additional SM.     

Comparison of Cryoballoon and Radiofrequency Ablation of Pulmonary Veins in 40 Patients with Paroxysmal Atrial Fibrillation: A Case‐Control Study

Introduction: Ablation of pulmonary veins (PV) is an established therapeutic option for patients with symptomatic drug‐refractory paroxysmal atrial fibrillation (AF). Radiofrequency (RF) is currently the most widespread energy source for PV ablation. Cryothermal energy applied with a cryoballoon technique as an alternative has recently evolved. Methods and Results: In a case‐control setting, we compared 20 patients with paroxysmal AF who underwent their first PV ablation with the cryoballoon technique to 20 matched patients with conventional RF ablation. In the case of persistent electrical potentials after cryoballoon ablation, it was combined with ablation with a conventional cryocatheter. All patients performed daily event recording for 3 months after ablation procedure. Ablation parameters and success rate after 3 and 6 months were compared. In the cryoballoon group, the overall success rate was 55% (50% in the cryoballoon only group [14 patients] and 66% in the combination group [6 patients]), as opposed to the RF group with 45%. AF episode burden was lower after cryoballoon ablation. There was no significant difference between cryoballoon and RF ablation regarding procedure parameters. In the cryoballoon group, 3 phrenic nerve palsies occurred using the 23 mm balloon that resolved spontaneously. Conclusion: PV ablation with the cryoballoon technique is feasible and seems to have a similar success rate in comparison to RF ablation. Procedure‐ and fluoroscopy duration are not longer than in conventional RF ablation.     

射频消融治疗肝内血管旁转移瘤24例

目的:评价CT引导下射频消融治疗肝内血管(直径>3mm)旁转移瘤的疗效及安全性.方法:24例单发肝转移瘤患者行RFA治疗(年龄范围:36-95岁,男女比例18∶6),所有病灶均在肝内直径>3mm的血管旁.肿瘤直径为:1.7-5.1cm.对照组选择同期行RFA的单发肝脏转移瘤患者,且病灶远离血管或者胆囊等,共25例.术后1、3、6、12、24mo分别行影像学检查随访.结果:24例患者共24个病灶接受了治疗.20例患者(83%)获得了完全的肿瘤坏死.4例患者出现了病灶周边不规则的强化,接受了再次治疗.2年随访肿瘤局部控制率为50%.试验组仅1例患者出现肝内小血肿,其余患者均未发生血管相关并发症.结论:即使紧邻肝内大血管的转移瘤,行RFA仍然安全、有效,并发症少,肿瘤进展率低.     

Electrogram-Guided Radiofrequency Catheter Ablation of Atrial Tissue Comparison with Thermometry-Guide Ablation

Objectives: To characterize a new method for radiofrequency energy titration during ablation of atrial tissue based on reduction in electrogram amplitude. To compare this method with energy titration using electrode thermometry. Background: Complications associated with anatomy-based atrial endocardial radiofrequency ablation for suppression of atrial fibrillation may be due to flawed methods of energy titration. Methods: The effect of radiofrequency ablation on electrogram amplitude was characterized in a porcine model. A method for energy titration guided by electrogram amplitude reduction (electrogram-guided) was developed and validated prospectively. Focal (smooth and trabeculated endocardial areas) and linear (smooth endocardial areas) ablation was performed comparing energy titration guided by amplitude reduction with electrode thermometry. Results: Amplitude reduction during radiofrequency application was not necessarily equal among unipolar and bipolar electrograms in the ablation region; specific patterns of reduction could be discerned, based on factors such as catheter-endocardial orientation. A criterion of >90% reduction of unipolar and/or bipolar amplitude best predicted pathologic lesion success. Electrogram-guided focal and linear lesions in smooth areas were free of lesion complications such as endocardial charring, barotrauma, or damage to contiguous extraatrial structures. However, there was a significant incidence of insufficient lesion size, principally non-transmurality, probably due to undertitration of energy. Thermometry-guided focal and linear lesions in smooth areas were uniformly transmural but frequently evidenced complications, due to overtitration of energy. Electrogram-guided focal lesions in trabeculated areas could usually not be achieved, probably due to insufficient contact of the ablation electrode with adjacent pectinate muscles. Thermometry-guided focal lesions in trabeculated areas were smaller than electrogram-guided lesions and did not evidence complications. Conclusions: Electrogram-guided lesions in smooth endocardial areas were uncomplicated but had a significant incidence of non-transmurality. Thermometry-guided lesions were uniformly transmural but were frequently complicated.     

Radiofrequency and cryoballoon ablation improve cognitive function in patients with atrial fibrillation

Atrial fibrillation is considered to be the most common arrhythmia in the clinic, and it gradually increases with age. In recent years, there has been increasing evidence that atrial fibrillation may exacerbate the progression of cognitive dysfunction. The current guidelines recommend ablation for drug-refractory atrial fibrillation.We aimed to prospectively analyze changes in cognitive function in patients with atrial fibrillation following treatment using different ablation methods.A total of 139 patients, with non-valvular atrial fibrillation, were included in the study. The patients were divided into the drug therapy (n = 41) and catheter ablation (n = 98) groups, with the catheter ablation group further subdivided into radiofrequency ablation (n = 68) and cryoballoon (CY) ablation (n = 30). We evaluated cognitive function at baseline, 3- and 12-months follow-up using the Telephone Interview for Cognitive Status-modified (TICS-m) test, then analyzed differences in cognitive function between the drug therapy and catheter ablation groups, to reveal the effect of the different ablation methods.We observed a significantly higher TICS-m score (39.56 ± 3.198) in the catheter ablation group at 12-month follow-up (P < .001), than the drug treatment group was. Additionally, we found no statistically significant differences in TICS-m scores between the radiofrequency ablation and CY groups at 3- and 12-month postoperatively (P > .05), although the two subgroups showed statistically significant cognitive function (P < .001).Overall, these findings indicated that radiofrequency and CY ablation improve cognitive function in patients with atrial fibrillation.     

Cardiac Swelling Associated with Linear Radiofrequency Ablation in the Atrium

Objectives: To characterize myocardial swelling in response to application of endocardial radio- frequency ablation lesions. Background: In individual patients, we have observed that ablation in the posterior right atrium was associated with echocardiographic evidence of atrial and contiguous right pulmonary vein wall swelling. Methods: 1. Human Subjects: linear ablation was performed in the posterior right atrium in 10 subjects; a portion of the ablation lesion was contiguous to the right pulmonary vein; this area was defined as the contiguity zone. In the contiguity zone, right atrial wall thickness and pulmonary vein lumen diameter were measured utilizing intracardiac echocardiography. Measurements were made just prior to (baseline) and immediately after ablation.2. Porcine Subjects: linear ablation was performed in the posterior right atrium of 14 pigs. In the contiguity zone, atrial wall thickness, interstitial space thickness, right pulmonary vein wall thickness and lumen diameter were measured using intracardiac echocardiography. Measurements were made at baseline, immediately after ablation, and at 1, 4, 8 or 12 weeks after ablation (followup). Post-mortem pathologic evaluation of the contiguity zone was performed. Results: 1. Human Subjects: Immediately after ablation, relative to baseline right atrial wall thickness was significantly increased (9.4±3.1[emsp4 ]mm versus 5.4±1.5[emsp4 ]mm) and right pulmonary vein lumen diameter was significantly decreased (6.2±2.9[emsp4 ]mm versus 8.1±2.9[emsp4 ]mm).2. Porcine Subjects: Immediately after ablation, right atrial wall thickness (4.1±1.2[emsp4 ]mm), interstitial space thickness (1.9±1.1[emsp4 ]mm), and right pulmonary vein wall thickness (1.2±0.4[emsp4 ]mm) were each significantly increased relative to baseline (1.0±0.3[emsp4 ]mm, 0±0[emsp4 ]mm, and 0.7±0.2[emsp4 ]mm, respectively) and pulmonary vein lumen diameter was significantly decreased (5.0±1.4[emsp4 ]mm versus 6.9±2.2[emsp4 ]mm). Similar findings were made at the 1 week followup interval. At 4, 8 and 12 week followup intervals, thicknesses and lumen diameter were not significantly different from baseline. At post-mortem examination, direct measurements of wall thickness were significantly correlated with echocardiographic measurements. Histologic analysis demonstrated edema to be the cause of the early wall thickness and lumen diameter changes. Ablation lesions were transmural in the right atria of all animals; in some animals, lesion formation was also observed in the pulmonary vein wall. Conclusions: Cardiac edema resulting from right atrial linear ablation results in swelling of atrial and contiguous right pulmonary vein walls, as well as the interposed extracardiac interstitial space. These changes are associated with a decrease in pulmonary vein lumen diameter. Swelling evolves rapidly and resolves within 4 weeks.     

单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.     

单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.     

单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.     

单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.     

Accessory Pathway with Two Conduction Times

A 48-year old man was referred for frequent paroxysmal narrow QRS tachycardias. Either a rapid orthodromic tachycardia (220 b/min) using a fast-conducting left lateral concealed atrioventricular (AV) accessory pathway (AP) for its retrograde conduction or a slow orthodromic tachycardia (125 b/min) using the same concealed AP which was slow-conducting, were induced. One application of radiofrequency energy at the earliest site of retrograde conduction suppressed both forms of tachycardias. Reciprocating tachycardias presenting with different retrograde conduction times were related to a single reentrant circuit.     

Linear Ablation Using an Irrigated Electrode Electrophysiologic and Histologic Lesion Evolution Comparison with Ablation Utilizing a Non-Irrigated Electrode

Objectives: To characterize the electrophysiologic and histologic sequelae of linear atrial ablation utilizing an irrigated electrode. To compare irrigated lesions with lesions deployed using the same electrode in a non-irrigated mode. Background: Previous reports of radiofrequency catheter ablation using an irrigated electrode have emphasized its favorable effect on lesion depth. We hypothesized that electrode irrigation would also benefit linear ablation of smooth atrial myocardium, a relatively superficial target. Methods: In healthy pigs, lesions were deployed in the right and left atria. Acutely, lesions resulting from ablation using an irrigated electrode, with radiofrequency energy titration guided by electrogram amplitude reduction, were compared to lesions using the same electrode without irrigation, with energy titration guided by electrode thermometry. Irrigated lesions were also assessed serially. Results: Acutely, irrigated lesions formed complete conduction barriers and were uncomplicated. In contrast, non-irrigated lesions formed complete conduction barriers but were frequently complicated, exhibiting endocardial charring, barotrauma, and pericardial damage. The rate and pattern of histologic evolution of irrigated lesions were uniform throughout each lesion; right and left atrial lesions healed similarly. During healing, 90% of lesions remained complete conduction barriers and 10 % manifested single discrete conduction gaps where viable appearing myocytes bridged the lesion. Conclusions: Complete, uncomplicated linear lesions could be reliably deployed in either atrium with an irrigated electrode. Not all lesions remained complete barriers to conduction during their histologic evolution. Lesions deployed with the same electrode ina non-irrigated mode were complete but frequently complicated.     

单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.     

单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.     

单纯环肺静脉前庭隔离术治疗持续性心房颤动:单中心三年随访结果

Objective To report the long-term outcome of catheter radiofrequency ablation treatment for patients with persistent atrial fibrillation (PerAF) and discuss the impact of PerAF duration and the termi-nation on the therapeutic outcome. Methods Eight-six consecutive PerAF patients underwent circumferential pulmonary vein antrum isolation (CPVAI) only were included in this study. Based on PerAF duration, patients were divided into two groups: short term (≤1 year, n =47) and long term (> 1 year, n =39). Results The mean follow-up period was 25-50 (36 ± 8) months. During the follow-up period, the success rate after single procedure was 30. 2% (26/86). Late recurrence phenomenon, defined as atrial tachyarrhythmias relapsed 1 year later, was observed in 9 patients (10.5%). The long-term success rate in the short term group was signifi-cantly higher than that in long term group (42.5% vs 15.4% ,P <0.01). During the first procedure, atrial fi-brillation converted into sinus rhythm or atrial tachycardia occurred in 29 patients (33.7%). Compared with the another 57 patients, the long-term outcome of these patients was much better (48.3% vs 21.1% ,P < 0.01). Redo procedures were pedormed in 24 patients (27.9%), which increased the total success rate at 3 years follow-up to 41.9% (36/86). Conclusion The long-term outcome treated with CPVAI in patients with PerAF is still unsatisfactory. In addition, the late recurrence is common. Shorter term of PerAF and terminated by ablation indicate that those patients might get more benefit from the CPVA1 treatment.