Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter

INTRODUCTION: The aims of this study were to identify predictors of recurrence after catheter ablation of atrial fibrillation (AF) and to report the safety and efficacy of catheter ablation of AF using an irrigated-tip ablation catheter. METHODS AND RESULTS: Seventy-five consecutive patients (51 men [68%]; age 54 +/- 13 years) with symptomatic drug-refractory paroxysmal (42 patients), persistent (21 patients), or permanent (12 patients) AF underwent catheter ablation of AF using an irrigated-tip ablation catheter and a standard ablation strategy, which involved electrical isolation of all pulmonary veins (PVs) and creation of a cavotricuspid linear lesion. At 10.5 +/- 7.5 months of follow-up following a single (n = 75) or redo ablation procedure (n = 11), 39 (52%) of the 75 patients were free of AF, 10 were improved (13%), and 26 had experienced no benefit from the ablation procedure (35%). Seventy-six percent of patients with paroxysmal AF were free from recurrent AF. The most significant complications were two episodes of pericardial tamponade, mitral valve injury in one patient, two strokes, and complete but asymptomatic PV stenosis in one patient. Cox proportional hazards multivariate regression analysis identified the presence of persistent AF, permanent AF, and age >50 years prior to the ablation are the only independent predictors of AF recurrence after the first PV isolation procedure. CONCLUSION: Catheter ablation of AF using a strategy involving isolation of all PVs and creation of a linear lesion in the cavotricuspid isthmus using cooled radiofrequency energy is associated with moderate efficacy and an important risk for complications. The best results of this procedure are achieved in the subset of patients who are younger than 50 years and have only paroxysmal AF.     

Substrate Ablation in Treatment of Atrial Fibrillation

From the time catheter ablation of atrial fibrillation (AF) was first reported, of the two dominant approaches for AF ablation, only pulmonary vein (PV) isolation has been modified, while circumferential pulmonary vein ablation (CPVA) as performed by our group in Milan has remained substantially unmodified. In fact, PV isolation as initially performed by Haissaguerre et al. has undergone rapid evolution toward substrate modification with significantly higher success rates without major complications. Modification of such technique was due to modification of the substrate. It is now evident that substrate modification is indeed crucial for curing AF particularly in patients with long-lasting or permanent AF. Indeed, to achieve good outcomes, any ablation technique should simultaneously include elimination of all triggers associated with modification of both anatomic and autonomic substrate, as we started to do many years ago by performing CPVA.     

Hybrid epicardial and endocardial ablation of persistent or permanent atrial fibrillation: a new approach for difficult cases

Background : Although percutaneous epicardial catheter ablation (PECA) has been used for the management of epicardial ventricular tachycardia, the use of PECA for atrial fibrillation (AF) has not yet been reported.
Objective: To evaluate the efficacy and feasibility of a hybrid PECA and endocardial ablation for AF.
Methods: We performed PECA for AF in five patients (48.6 ± 8.1 years old, all male, four redo ablation procedures of persistent AF with a risk of pulmonary vein (PV) stenosis, one de novo ablation of permanent [AF]) after an endocardial AF ablation guided by PV potentials and 3D mapping (NavX). Utilizing an open irrigation tip catheter, a left atrial (LA) linear ablation from the roof to the perimitral isthmus or localized ablation at the junction between the LA appendage and left-sided PVs or ligament of Marshall (LOM) was performed.
Results: PECA of AF was successful in all patients with an ablation time of <15 minutes. The left-sided PV potentials were eliminated by PECA in all patients. Bidirectional block of the perimitral line was achieved in two of two patients and a left inferior PV tachycardia with conduction block to the LA was observed during the ablation in the area of the LOM in one patient. A hemopericardium developed in one patient, but was controlled successfully. During 8.0 ± 6.3 months of follow-up, all patients have remained in sinus rhythm (four patients without antiarrhythmic drugs).
Conclusion: A hybrid PECA of AF is feasible and effective in patients with redo-AF ablation procedures and at risk for left-sided PV stenosis or who are resistant to endocardial linear ablation.     

Ablation of focal atrial fibrillation

In the past decades management of atrial fibrillation (AF) has been based mainly on drug therapy. New insights into the pathophysiology of AF initiation and maintenance have provided the background for the design of catheter based procedures. The crucial role of the pulmonary veins (PVs) as triggers of AF paved the way for successful mapping and ablation. Electrical isolation of all PVs using the circular mapping approach has been shown to be an effective procedure, with reported success rates around 70 to 80% in most series. Intracardiac echocardiography is a very helpful adjunctive tool to facilitate correct positioning of the circular catheter at the PV-left atrial junction, as well as to monitor energy delivery and assist transseptal left atrial access. PV stenosis is a potential serious complication, occurring in around 2% of cases. It presents mainly with respiratory symptoms, although it is frequently asymptomatic. Spiral computed tomography is a reliable non-invasive method for imaging the PVs and can be used to screen patients for PV stenosis after radiofrequency ablation. In symptomatic patients, PV dilatation and stenting is the preferred treatment approach.The possibility of curing AF represents a major breakthrough in invasive cardiac electrophysiology. Isolation of all PVs is a very solid endpoint for successful ablation and should be pursued in all patients. It seems to be associated with high success rates over long term follow-up. Future refinements in catheter technology should provide simpler and faster procedures and render catheter ablation of AF more widespread and accepted.     

Prevalence of asymptomatic recurrences of atrial fibrillation after successful radiofrequency catheter ablation

INTRODUCTION: The long-term efficacy of radiofrequency catheter ablation of atrial fibrillation (AF) has been based on patient-reported symptoms suggestive of AF. However, asymptomatic recurrences of AF may remain undetected. The aim of this study was to determine the prevalence of asymptomatic recurrences of AF after an apparently successful catheter ablation procedure for AF. METHODS AND RESULTS: Among 244 consecutive patients (mean age 53 +/- 11 years) who underwent a pulmonary vein isolation procedure for symptomatic paroxysmal AF and who reported no symptoms of recurrent AF at > or =6 months after the procedure, 60 patients with a history of > or =1 episode of AF per week were asked to participate in this study. Preablation, these patients had experienced 19 +/- 13 episodes of AF per month. The patients were provided with a patient-activated transtelephonic event recorder for 30 days, a mean of 642 +/- 195 days after the ablation procedure, and were asked to record and transmit recordings on a daily basis and whenever they felt palpitations. Seven patients (12%) felt palpitations during the study, although they had not experienced symptoms previously. Each of these 7 patients had an episode of AF documented with the event monitor during symptoms. In these 7 patients, the mean number of episodes per month decreased from 19 +/- 14 preablation to 3 +/- 1 postablation (P < 0.001). Among the 53 asymptomatic patients, an episode of AF was captured in 1 (2%) patient during the study period. CONCLUSION: Asymptomatic recurrences of AF after an apparently successful catheter ablation procedure for symptomatic paroxysmal AF are infrequent.     

Cerebrovascular complication associated with pulmonary vein ablation

INTRODUCTION: Radiofrequency (RF) ablation has become an established treatment modality for patients with paroxysmal atrial fibrillation (AF). A principal limitation of RF catheter ablation is the risk of thromboembolism. Stroke as a complication after ablation of triggers of AF has not been previously reported. METHODS AND RESULTS: Fifty-six patients underwent RF ablation for a focal source of AF. Forty-nine patients (86%) had AF triggers in > or = 1 pulmonary vein. Mean procedure time was 227 +/- 74 minutes. Cerebrovascular event occurred in 3 (5%) patients, all >60 years old. Two of the three patients had a prior history of transient ischemic attacks. CONCLUSION: The risk of stroke from RF ablation may be higher in paroxysmal AF patients with prior transient ischemic attack.     

70岁以上心房颤动患者导管射频消融治疗临床分析

目的 分析70岁以上心房如动(房颤)患者导管射频消融治疗成功率及术后复发危险因素.方技,选择导管射频消融的70岁以上房颤患者107例,收集患者临床和电生理资料,采用Cox比例风险回归模型分析房颤消融术后复发危险因素.结果 107例患者中,阵发性房颤89例.持续性房颤18例.平均随访(25.2±11.5)个月,单次消融成...     

Long-term management of atrial fibrillation

In the past decade, catheter ablation techniques and implantable devices have revolutionized the treatment of ventricular arrhythmias, junctional arrhythmias, and atrial flutter. For most patients presenting with atrial fibrillation (AF), the treatment available today is similar to that used a century ago, although nonpharmacologic strategies of therapy have begun to emerge for selected cases. There have been important recent advances in our understanding of the pathophysiology of AF and its complications, and it may be possible to improve patient management by refinement of the way in which current drugs are used.     

Right Atrial Mapping and Linear Ablation for Paroxysmal Atrial Fibrillation

Objective: Catheter ablation techniques to cure atrial fibrillation (AF) are under investigation. This study evaluates a mapping-based, individualized approach to right atrial (RA) linear ablation in patients with paroxysmal AF. Methods: In this prospective observational study, 29 patients with recurrent symptomatic AF refractory to medical therapy, underwent linear ablation between May 1998 and December 1999. Inclusion criteria were symptomatic paroxysmal AF, failure of at least 2 antiarrhythmic medications, and informed consent. Radiofrequency ablation was performed in the RA using a 3.3 French multielectrode catheter, ablating through sequential electrodes to establish linear lesions. Lesions were delivered during sustained AF, guided by an empiric mapping scheme, targeting arrhythmogenic areas noted during electrophysiologic testing in sinus rhythm and areas of most disorganization during AF. Reinduction of AF was attempted at the end of successful ablation. Results: The mean age was 58 years. There were 15 male and 14 female patients. Sustained AF was inducible in all patients at electrophysiology study. Acute success was achieved in 24 patients (83%). Long term success (maintaining sinus rhythm off antiarrhythmic medications) was seen in 23 (79%) over a mean follow-up of 19.7 months. Ablation lines varied from patient to patient. There were no complications. Conclusions: Individualized linear ablation in the RA using a multielectrode catheter system can produce effective suppression of paroxysmal AF. Ablation during AF, and testing to reinduce AF at the end of the procedure, make this study unique.     

Complications of catheter ablation for atrial fibrillation: incidence and predictors

Introduction: Pulmonary vein (PV) isolation by catheter ablation is an increasingly used strategy to treat atrial fibrillation (AF). Complication rates from AF ablation reported in different case series vary widely. We conducted a retrospective analysis of 641 consecutive ablation procedures to assess complication rates, temporal trends, and clinical predictors of adverse outcomes.
Methods: All patients (n = 517) undergoing catheter ablation for AF at Johns Hopkins Hospital between February, 2001 and June, 2007 were prospectively enrolled in a database. Data from 641 consecutive procedures were analyzed and complications considered if they occurred within 30 days of ablation. Major complications were defined as those that required intervention, resulted in long-term disability, or prolonged hospitalization.
Results: Thirty-two major complications occurred in 641 procedures (5%). Among the patients with major complications, seven had cerebrovascular accident (CVA), eight had tamponade, one had PV occlusion with hemoptysis, and 11 had vascular injury requiring surgical repair and/or transfusion. No periprocedural deaths occurred, and no instances of esophageal injury were seen. Complication rates were higher during the first 100 cases (9.0%) than during the subsequent 541 (4.3%). Major adverse clinical events were associated with age > 70 years (P = 0.007; odds ratio 3.7, 95% confidence interval 1.4–9.6) and female gender (P = 0.014; odds ratio 3.0, 95% confidence interval 1.3–7.2). No other clinical or procedural predictors of complication were identified.
Conclusions: Complication rates from AF ablation remain significant, despite improved techniques and increased awareness of procedural risks. Both advanced age and female gender predict major adverse events, suggesting careful consideration of the risk/benefit profile in these patients prior to ablation.     

Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation

Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts’ opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.     

Pulmonary vein antrum isolation for atrial fibrillation on therapeutic coumadin: special considerations

Pulmonary vein antrum isolation (PVAI) has emerged as an effective treatment for drug-refractory atrial fibrillation (AF). However, thromboembolic events are important complications of this approach. Management of anticoagulation is essential to prevent thromboembolic complications and avoid bleeding complications. The purpose of this review is to outline the general principles followed at our AF centers to address the important issue of pre-, peri-, and postprocedural anticoagulation strategies during PVAI of AF. We initiate warfarin therapy prior to the ablation procedure and continue it through the procedure. Prior work has demonstrated that continuation of therapeutic warfarin during the radiofrequency catheter ablation reduces the risk of periprocedural stroke/transient ischemic attack without increasing the risk of hemorrhagic events. In fact, a strategy that interrupts warfarin anticoagulation may increase the risk of stroke, even with bridging with enoxaparin. Data from our work have shown that minor bleeding was more frequent in the patients bridged with heparin or enoxaparin. There was no significant difference in incidence of major bleeding complications among the patients with a therapeutic level of international normalized ratio (INR) compared with patients for whom bridging therapy was used. Furthermore, the strategy of ablation during a therapeutic INR could be more economical compared with bridging therapy with enoxaparin. Continuation of therapeutic warfarin during ablation of AF may be the best strategy, especially in patients with nonparoxysmal AF, patients with higher thromboembolic risk scores, and patients who require extensive ablation during PVAI of AF.     

Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function

BACKGROUND: The effects of left atrial (LA) circumferential ablation on LA function in patients with atrial fibrillation (AF) have not been well described. OBJECTIVES: The purpose of this study was to determine the effect of LA circumferential ablation on LA function. METHODS: Gated, multiphase, dynamic contrast-enhanced computed tomographic (CT) scans of the chest with three-dimensional reconstructions of the heart were used to calculate the LA ejection fraction (EF) in 36 patients with paroxysmal (n = 27) or chronic (n = 9) AF (mean age 55 +/- 11 years) and in 10 control subjects with no history of AF. Because CT scans had to be acquired during sinus rhythm, a CT scan was available both before and after (mean 5 +/- 1 months) LA circumferential ablation (LACA) in only 10 patients. A single CT scan was acquired in 8 patients before and in 18 patients after LACA ablation. Radiofrequency catheter ablation was performed using an 8-mm-tip catheter to encircle the pulmonary veins, with additional lines along the mitral isthmus and the roof. RESULTS: In patients with paroxysmal AF, LA EF was lower after than before LACA (21% +/- 8% vs 32 +/- 13%, P = .003). LA EF after LA catheter ablation was similar among patients with paroxysmal AF and those with chronic AF (21% +/- 8% vs 23 +/- 13%, P = .7). However, LA EF after LA catheter ablation was lower in all patients with AF than in control subjects (21% +/- 10% vs 47% +/- 5%, P < .001). CONCLUSION: During medium-term follow-up, restoration of sinus rhythm by LACA results in partial return of LA function in patients with chronic AF. However, in patients with paroxysmal AF, LA catheter ablation results in decreased LA function. Whether the impairment in LA function is severe enough to predispose to LA thrombi despite elimination of AF remains to be determined.     

Cerebral diffusion-weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation

INTRODUCTION: Cerebral embolism and stroke are feared complications of left atrial catheter ablation such as pulmonary vein (PV) ablation. In order to assess the thrombogenicity of left atrial catheter ablation, knowledge of both clinically evident as well as silent cerebral embolism is important. The aim of the current study was to examine the use of diffusion-weighted magnetic resonance imaging (DW-MRI) for detection of cerebral embolism, apparent as well as silent, caused by PV catheter ablation. METHODS AND RESULTS: Twenty consecutive patients without structural heart disease undergoing lasso catheter-guided ostial PV ablation using an irrigated-tip ablation catheter were studied. Cerebral MRI including DW single-shot spin echo echoplanar, turbo fluid attenuated inversion recovery, and T2-weighted turbo spin echo sequences were performed the day after the ablation procedure. Ten patients also underwent preprocedure cerebral MRI. All ablation procedures were performed without acute complications. A mean of 3.2 +/- 0.6 PVs were ablated per patient. No patient had neurological symptoms following the procedure. In 2 of 20 patients (10%), DW-MRI revealed new embolic lesions, which were located in the right periventricular white matter in one and in the left temporal lobe in the other patient. There was no statistically significant difference in age, history of hypertension, left atrial volume, and procedure duration between the 2 patients with and the 18 patients without cerebral embolism following AF ablation. CONCLUSION: This is the first study using highly sensitive DW-MRI of the brain to detect asymptomatic cerebral embolism after left atrial catheter ablation. Even small, clinically silent, embolic lesions can be demonstrated with this technique. DW-MRI can be used to monitor and compare the thrombogenicity of different AF ablation approaches.     

三维电解剖标测指导下经导管射频消融治疗心房颤动的初步体会

目的探讨在三维电解剖标测系统(CARTO)指导下经导管射频消融治疗心房颤动(房颤)的安全性和有效性。方法将接受治疗的30例患者(阵发性房颤28例,持续性房颤2例)利用CARTO进行左心房重建后,对阵发性房颤患者行环绕同侧肺静脉的线性消融,射频消融终点为房颤终止且不能诱发;对持续性房颤患者进行左心房和冠状静脉窦的重建,标测射频消融复杂心房碎裂电位区,至房颤终止或行直流电转复。并检测其中16例阵发性房颤患者术后心脏生化标记物动态变化。结果28例阵发性房颤均达到射频消融终点,2例持续性房颤患者中,1例在射频消融中转为窦性心律,1例行直流电转复。术后随访2~14(5.6±3.5)个月,25例患者无房颤复发,单次手术成功率83.3%。16例患者术后第1天肌钙蛋白T由术前的(0.01±0.00)μg/L升至(2.20±0.99)μg/L(P<0.01)。结论在CARTO指导下射频消融治疗房颤安全有效,但肌钙蛋白T明显增高。     

Robotic navigation in catheter ablation for paroxysmal atrial fibrillation: midterm efficacy and predictors of postablation arrhythmia recurrences

Robotic Navigation in Ablation of Paroxysmal AF . Introduction: Remote navigation systems represent a novel strategy for catheter ablation of atrial fibrillation (AF). The goal of this study is to describe a single‐center experience with the electromechanical robotic system (Sensei, Hansen Medical) in treatment of patients with paroxysmal AF. Methods: Out of 200 patients who underwent robotically guided ablation for AF between 2007 and 2009 at our institute, 100 patients (29 women, age 56.5 ± 10 years) had paroxysmal AF refractory to antiarrhythmic drugs. Electroanatomic mapping using NavX system (St. Jude Medical) provided anatomical shell for subsequent circumferential ablation with robotic catheter (Artisan) loaded with a 3.5‐mm, open‐irrigation, cooled‐tip ablation catheter. Results: A mean of 69 radiofrequency current applications (duration 2082 ± 812 seconds) were delivered to achieve circumferential electrical isolation of pulmonary venous antra. Total procedural time reached 222 ± 54 minutes. The mean fluoroscopic time was 11.9 ± 7.8 minutes. There were no major procedure‐related complications. After a median follow‐up of 15 months (range 3‐28 months), 63% of the patients were free from any atrial arrhythmias ≥ 30 seconds after the single procedure. Success rate increased to 86% after 1.2 procedures. Multivariate analysis revealed that only predictor of recurrent AF/AT was shorter overall procedural time (207 ± 36 vs 236 ± 64 minutes in patients with and without recurrences, respectively, P = 0.0068). Conclusions: This study demonstrates feasibility and safety of robotic navigation in catheter ablation for paroxysmal AF. Midterm follow‐up documents success rate comparable to other technologies and potential for improvement in more extensive ablation along the ridges with thicker myocardium. (J Cardiovasc Electrophysiol, Vol. 22, pp. 534‐540 May 2011)     

心房颤动导管消融术后复发的危险因素分析

心房颤动是最常见的心律失常之一。导管消融已经成为心房颤动的有效治疗手段,具有较高的手术成功率,特别是阵发性心房颤动,术后成功率更高。然而,导管消融术后复发仍不少见,特别是慢性心房颤动。影响心房颤动经导管消融术后复发的危险因素是多方面的,包括体重、年龄、心房颤动持续时间、炎症、心房纤维化、左房疤痕、左房大小等,识别这些危险因素对指导个体化治疗及提高导管消融的成功率有一定的意义。因此,现对这些危险因素与心房颤动导管消融术后复发的关系做一综述。     

CT定量评价左心耳解剖结构与心房颤动射频消融术后复发的相关性研究

目的:采用256层螺旋CT定量评价左心耳解剖结构与心房颤动(房颤)射频消融术后复发的关系。方法:研究纳入83例首次进行射频消融术的房颤患者,平均年龄(60.36±10.11)岁,男性49例(59.04%)。所有患者术前均行256层螺旋CT检查,测量左心房体积、左心耳体积、左心耳开口周长、短径、长径、深径并收集患者临床资料。83例房颤患者行射频消融术后中位随访时间19(4~24)个月,27例(32.53%)患者复发。根据有无复发分为复发组(n=27例)和未复发组(n=56例)。结果:对83例患者的临床资料进行分析,复发组持续性房颤患者及心力衰竭(心衰)患者较未复发组比例更高,CHA2DS2-VASc评分更高(P均<0.05);对左心耳解剖结构分析,左心房体积、左心耳体积、左心耳开口周长、短径、长径、深径,复发组均大于未复发组(P均<0.05);多因素Cox比例风险回归分析显示较大的左心耳体积是房颤复发的独立预测因子(HR=1.160,95%CI:1.095~1.229,P<0.001);左心耳体积>9.25 ml对射频消融术后复发具有一定预测价值,敏感度85.2%、特异度67.9%、AUC 0.82,房颤复发率较高(P<0.00l)。结论:房颤会造成心脏结构重构,左心耳各解剖径线明显增大可能是房颤射频消融术后复发的原因,并且发现左心耳体积增大是房颤射频消融术后复发的独立预测因子。     

Our Approach to Maximizing the Durability of Pulmonary Vein Isolation During a Paroxysmal Atrial Fibrillation Ablation Procedure

Maximizing Lesion Durability in PVI. Recurrence of atrial fibrillation (AF) after a single ablation procedure has been reported in the range of 15–60% depending on patient selection. A major factor leading to AF recurrence after catheter ablation therapy is electrical reconnection of one or more pulmonary veins (PVs) due to recovery of excitability of atrial tissue within ablation lesions. Maximizing the durability of pulmonary vein isolation (PVI) is critical to reduce recurrence rates and improve outcome after catheter treatment for AF. Strategies to increase the durability of the lesions include optimization of catheter contact by use of steerable sheaths, direct visualization by intracardiac ultrasound, and observation of the decrease in impedance at the beginning of ablation. Furthermore, currently achievable endpoints in addition to electrical PVI may reduce AF recurrence, such as identification of dormant conduction with adenosine administration and rendering the ablation line unexcitable to pacing. Integration of all these strategies into routine catheter ablation procedures for AF has reduced our AF recurrence rates and can easily be incorporated into practice without additional technological advances. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1272–1276, November 2012)     

Outcomes of Ablation of Paroxysmal Atrial Fibrillation in Patients on Chronic Hemodialysis

AF Ablation in HD Patients . Introduction: It is not common for patients on chronic hemodialysis (HD) to undergo catheter ablation of atrial fibrillation (AF). We aimed to show the outcomes of AF ablation in the HD patients. Methods and Results: Thirty HD patients who underwent pulmonary vein (PV) isolation for drug refractory paroxysmal AF were retrospectively studied, and their AF recurrence free rate and frequency of periprocedural complications were compared to 60 age‐ and gender‐matched control patients not requiring HD. A nonirrigated ablation catheter was used in both patient groups. During a mean follow‐up period of 821 ± 218 days, 16 (54%) of the HD patients remained free from AF recurrence without any antiarrhythmic agents versus 47 (78%) of the control patients with an initial ablation (P = 0.013). A second ablation procedure was performed in 12 patients with an AF recurrence, and consequently 20 (67%) of the HD patients were in sinus rhythm compared to 53 (88%) of the controls during a follow‐up duration of 747 ± 221 after the last ablation (P = 0.012). Bleeding from the venipuncture site requiring a prolonged hospital stay was identified in 2 HD patients and 1 control subject, while no life‐threatening complications were observed in either patient group. Conclusion: Although the success rate of the PV isolation in HD patients was far from satisfactory, it may be considered as one of the therapeutic options for them. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1289‐1294, December 2012)