探讨半月神经节不同温度模式射频在老年三叉神经痛中的治疗效果

目的探讨半月神经节不同温度模式射频在老年三叉神经痛(TN)中的治疗效果。方法选取我院2015年4月~2016年7月收治的TN患者80例,随机数字表法分为观察组和对照组各40例。对照组采用75℃+脉冲射频治疗,观察组采用70℃+脉冲射频治疗。对比两组手术前后面部疼痛、麻木评分、生活质量评分及临床疗效。结果两组术前面部疼痛、麻木评分、生活质量评分比较,差异无统计学意义(P0.05),术后3个月观察组面部疼痛、麻木评分低于对照组,生活质量评分高于对照组,差异有统计学意义(P0.05)。观察组治疗总有效率92.50%低于对照组70.00%,差异有统计学意义(P0.05)。方法半月神经节不同温度模式射频可有效治疗老年TN,其中70℃+脉冲射频效果显著,可有效改善患者面部疼痛、麻木症状,减轻患者痛苦,提高生活质量。     

超声引导下星状神经节脉冲射频联合电针治疗偏头痛患者的疗效观察

目的 观察超声引导下星状神经节脉冲射频联合电针治疗偏头痛患者的临床疗效。 方法 采用随机数字表法将72例偏头痛患者分为联合组、针刺组及对照组,每组24例。3组患者均给予依托考昔及佐米曲普坦分散片口服,电针组患者在此基础上辅以电针治疗（每天治疗1次,连续治疗7 d）,联合组患者则辅以超声引导下星状神经节脉冲射频（共治疗1次）及电针治疗（每天治疗1次,连续治疗7 d）。于治疗前、治疗后3 d、7 d、30 d及90 d时分别采用疼痛视觉模拟评分法（VAS）、偏头痛特异性生活质量问卷（MSQoL）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）及偏头痛失能程度问卷（MIDAS）对3组患者进行疗效评估。 结果 治疗后3 d、7 d、30 d、90 d时联合组、针刺组疼痛VAS、MSQoL、HAMA及HAMD评分均较治疗前明显改善（P<0.05）,治疗后30 d、90 d时联合组及针刺组MIDAS评分均较治疗前明显改善（P<0.05）。治疗后3 d时联合组疼痛VAS、MSQoL、HAMA及HAMD评分均显著优于针刺组（P<0.05）,治疗后30 d、90 d时联合组MIDAS评分均显著低于针刺组（P<0.05）。治疗后3 d、7 d、30 d、90 d时联合组疼痛VAS、HAMA、HAMD评分均显著低于对照组（P<0.05）,MSQoL评分显著高于对照组（P<0.05）,治疗后30 d及90 d时联合组MIDAS评分均显著低于对照组（P<0.05）。 结论 超声引导下星状神经节脉冲射频联合电针治疗能在短期内迅速缓解偏头痛患者症状,提高生活质量,且疗效持续时间至少达3个月。     

半月神经节射频热凝术中针尖裸露长度和射频温度对三叉神经痛疗效及并发症的影响

摘要 目的：探讨不同针尖长度的穿刺套管针及不同射频温度对于半月神经节射频热凝术的三叉神经痛缓解、术后复发及面部麻木等并发症的关系。 方法：80例原发性三叉神经痛的患者,随机分为四组,均在CT引导下经皮行穿刺半月节射频热凝手术,A组应用穿刺套管针针尖裸露端长为5mm的射频针进行治疗,持续热凝温度为75℃;B组针尖裸露端5mm,温度为70℃;C组针尖裸露端2mm,温度为75℃;D组针尖裸露端2mm,温度为70℃。射频热凝的时间均为120s,2次。术后24h、3d、7d、1m、3m随访观察4组间疼痛强度（VAS评分）,生存质量评分（QOL）,麻木范围及程度,以及咀嚼无力、角膜炎等并发症的发生率等有无显著差异。 结果：80例患者全部随访成功。4组患者术后3个月的VAS及QOL评分均较术前有明显的改善(P<0.05),且各组间差异无显著性(P>0.05)。术后所有患者均出现不同程度的面部麻木感(发生率100％),麻木程度评分随术后时间的延长逐渐降低,术后1个月及3个月时,A组麻木程度评分均明显高于B、C、D组,B组高于C、D组,C组的麻木程度评分也显著高于D组（P<0.05）。术后3m, A组的麻木范围和咀嚼无力发生率显著高于C、D两组（P<0.05）,B组显著高于D组。 结论：CT引导下半月节射频术治疗原发性三叉神经痛,是一种安全有效的治疗方法;在相同的射频温度下,应用针尖裸露端为2mm的穿刺套管针进行射频治疗,术后所产生的麻木范围、麻木程度以咀嚼无力明显少于针尖裸露端为5mm的穿刺套管针;应用相同穿刺套管针,75℃射频热凝,术后麻木程度评分明显高于70℃组。     

CT引导下半月神经节射频热凝加阿霉素毁损治疗三叉神经痛的疗效分析

目的观察CT引导下半月神经节射频热凝加阿霉素毁损治疗三叉神经痛的远近期疗效。方法对68例三叉神经痛患者CT引导下行半月神经节射频热凝加阿霉素毁损治疗。观察并记录术前后的疼痛视觉模拟评分(VAS),进行疗效评估,并随访2年,观察复发率。结果治疗后各时段VAS评分均降低,差异有统计学意义(P0.05);术后7 d后各时段与术后1 d疼痛VAS评分差异有统计学意义(P0.05);术后30 d后各时段与术后7 d疼痛VAS评分差异无统计学意义(P0.05);术后疗效各时段相比,差异无统计学意义(P0.05)。结论 CT引导下半月神经节射频热凝加阿霉素毁损治疗三叉神经痛,可以提高疗效,降低复发率,减少并发症,是一种治疗三叉神经痛的安全有效方法。     

背根神经节脉冲射频联合药物治疗带状疱疹后遗神经痛的临床疗效分析

目的:观察背根神经节脉冲射频联合药物治疗带状疱疹后遗神经痛(postherpetic neuralgia,PHN)的临床疗效分析。方法:60例胸背部PHN的患者,随机分为三组:A组(n=20)为单纯口服药物治疗组,B组(n=20)为经皮胸椎旁选择性神经根复方倍它米松阻滞联合药物口服治疗组,C组(n=20)经皮胸脊神经背根神经节脉冲射频联合口服药物治疗组。观察并比较三组术前、术后1周、4周、8周、及12周的视觉模拟评分(visual analogue scale,VAS)。结果:三组治疗后VAS评分较治疗前均有所下降(P<0.05)。与A组相比,B组和C组在术后VAS评分明显下降(P<0.05)。C组与B组术后VAS评分无显著性差异。结论:经皮背根神经节脉冲射频联合药物可有效治疗PHN。     

半月节脉冲射频治疗三叉神经痛的临床观察

目的 观察螺旋CT引导下半月节穿刺脉冲射频治疗三叉神经痛的临床疗效.方法 100例原发性三叉神经痛患者随机分为研究组(n=44,行半月节脉冲射频治疗)和对照组(n=56,行半月节射频热凝).比较治疗前、治疗后1 d、3 d、1周、1个月,6个月和12个月时的数字评分(NRS)及副作用发生情况.结果 治疗后两组各时间点NRS评分均较治疗前明显降低(P<0.01).对照组见效较快.治疗后随访1年两组疗效相当,研究组的副作用发生率低于对照组.结论 半月节脉冲射频治疗三叉神经痛安全有效、副作用少,适用于高龄、体弱的患者.     

50℃脉冲射频治疗三叉神经痛患者的临床效果

目的:探讨50℃脉冲射频治疗三叉神经痛患者的疗效及安全性。方法:对我院42℃标准脉冲射频治疗后效果欠佳的原发三叉神经痛患者32例行50℃脉冲射频治疗,评价治疗前后的疼痛程度数字评分(numerical rating scale,NRS),记录并发症发生情况。结果:42℃标准脉冲射频治疗后效果欠佳改行50℃脉冲射频治疗后NRS较治疗前明显降低(P<0.01),治疗后面部有轻度麻木感,但短期内(平均2.1月)即可完全恢复,无其他严重并发症发生。结论:50℃脉冲射频治疗三叉神经痛安全、有效,是42℃标准脉冲射频无效时的临床选择。     

CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛的疗效观察

目的 观察CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛的临床疗效。 方法 采用随机数字表法将88例颈段带状疱疹后神经痛患者分为对照组、电针组、脉冲射频组及联合组。4组患者均常规给予加巴喷丁、曲马多治疗,电针组在药物干预基础上给予电针围刺治疗;脉冲射频组在药物干预基础上给予CT引导下颈段背根神经节脉冲射频治疗;联合组则同时给予CT引导下颈段背根神经节脉冲射频及电针围刺治疗。于治疗前（即入组时）、治疗后15 d、治疗后30 d时分别观察各组患者疼痛程度及面积、心理情绪、生活质量改善情况。 结果 入组时4组患者疼痛视觉模拟评分（VAS）、汉密顿焦虑量表（HAMA）评分、汉密顿抑郁量表（HAMD）评分、皮肤疼痛面积及生活质量评估量表（QOL-SF36）评分组间差异均无统计学意义（P>0.05）。与入组时比较,电针组、脉冲射频组及联合组在治疗后15 d及1个月时,其疼痛VAS、HAMA、HAMD评分、皮肤疼痛面积、QOL-SF36评分均有明显改善（P<0.05）。治疗后15 d、1个月时,联合组患者疼痛VAS评分［分别为（2.59±1.01）分、（1.77±1.10）分］、HAMA评分［分别为（12.45±4.11）分、（11.31±3.82）分］、HAMD评分［分别为（20.22±6.50）分、（16.54±6.58）分］、皮肤疼痛面积［分别为（66.36±31.25）cm2、（53.68±29.89）cm2］及QOL-SF36评分［分别为（90.54±15.02）分、（101.95±19.84）分］与电针组、脉冲射频组及对照组比较,发现组间差异均具有统计学意义（P<0.05）。治疗后3个月时联合组患者加巴喷丁与曲马多使用量［分别为（1309.1±603.8）mg/d、（104.5±57.5）mg/d］均较电针组、脉冲射频组及对照组显著下降,组间差异均具有统计学意义（P<0.05）。 结论 CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛疗效确切,且安全性高、并发症少、风险低,该联合疗法值得临床推广、应用。     

体外冲击波联合背根神经节脉冲射频治疗脊柱源性腹痛的疗效观察

目的 观察体外冲击波联合背根神经节脉冲射频治疗脊柱源性腹痛的临床疗效。 方法 采用随机数字表法将88例脊柱源性腹痛患者分为对照组、冲击波组、脉冲射频组及联合组，所有患者均连续口服药物依托考昔、普瑞巴林3周；冲击波组患者在此基础上辅以体外冲击波治疗，脉冲射频组在此基础上辅以背根神经节脉冲射频治疗，联合组患者则辅以体外冲击波及背根神经节脉冲射频治疗。于治疗前、治疗1周、4周及12周时分别采用视觉模拟评分法（VAS）、生活质量评估量表（QOL-SF36）、汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）对4组患者进行疗效评定，并于治疗结束后2年随访4组患者疾病发展、胃肠道功能、就诊情况以及医疗花费等。 结果 治疗4周时发现4组患者疼痛VAS、QOL-SF36、HAMA及HAMD评分均较治疗前明显改善（P<0.05）；其中联合组疼痛VAS评分［（0.67±0.72）分］、QOL-SF36评分［（139.00±10.54）分］、HAMA评分［（3.81±3.78）分］及HAMD评分［（4.36±4.16）分］亦显著优于对照组、冲击波组及脉冲射频组水平，组间差异均具有统计学意义（P<0.05），并且联合组这种疗效优势持续保持至治疗12周时。治疗结束后通过2年随访，发现联合组患者胃肠道症状、就诊次数、医疗花费等均较对照组、冲击波组及脉冲射频组明显减少，组间差异均具有统计学意义（P<0.05）。 结论 体外冲击波联合背根神经节脉冲射频治疗脊柱源性腹痛临床疗效显著，同时还能显著降低患者医疗费用，具有明显经济、社会效益，值得临床推广、应用。     

背根神经节脉冲射频术联合椎间孔注射臭氧及复合液治疗带状疱疹后神经痛的效果

目的探讨背根神经节脉冲射频术联合椎间孔注射臭氧及复合液治疗带状疱疹后神经痛(PHN)的效果。方法将本院收治的88例PHN患者根据不同治疗方法分为对照组(n=44)和观察组(n=44)。两组患者均采用背根神经节脉冲射频术治疗,观察组在此基础上给予椎间孔注射臭氧及复合液治疗。比较两组的治疗效果。结果治疗后1、3个月,两组患者的PRI、VAS、PPI评分、SF-MPQ总分及睡眠质量评分均降低,且观察组低于对照组(P<0.05);两组均无显著不良反应。结论背根神经节脉冲射频术联合椎间孔注射臭氧及复合液可快速缓解PHN,改善患者睡眠质量。     

Lesion Size in Relation to Ablation Site During Radiofrequency Ablation

This study was designed to investigate the effect of the convective cooling of the tip of the ablation electrode during temperature controlled radiofrequency ablation. In vivo two different application sites in the left ventricle of anaesthetised pigs were ablated and in vitro ablation was performed during two different flow-velocities in a tissue bath, while electrode contact pressure and position were unchanged. Target temperature was 80 °C. Obtained tip temperature, power consumption and lesion dimensions were measured. In vivo lesion volume, depth and width were found significantly larger for septal applications than apical applications (p<0.01) and more power was used (p<0.001). Obtained tip temperature was significantly lower in the septal applications (p<0.001). In vitro increased convective cooling by induction of flow yielded larger lesion volume, depth and width (p<0.01), and had higher power consumptions (p<0.01). Obtained tip temperature did not differ significantly. For the given chosen target temperature power consumption was positively related to lesion volume (r= 0.66 in vivo and 0.65 in vitro), whereas obtained tip temperature was not (r = - 0.49 in vivo and - 0.61 in vitro). We conclude that during temperature controlled radiofrequency ablation lesion size differs for septal and apical left ventricular applications. Differences in convective cooling might play an important role in this respect. This is supported by our in vitro experiments, where increased convective cooling by induction of a flow around the electrode tip increases lesion dimensions and power consumptions. Furthermore we conclude that for the given target temperature the power consumption is positively correlated with lesion volume (p<0.001), whereas the obtained tip temperature is not.     

Expert consensus of Chinese Association for the Study of Pain on the radiofrequency therapy technology in the Department of Pain

On the basis of continuous improvement in recent years, radiofrequency therapy technology has been widely developed, and has become an effective method for the treatment of various intractable pain. Radiofrequency therapy is a technique that uses special equipment and puncture needles to output ultra-high frequency radio waves and accurately act on local tissues. In order to standardize the application of radiofrequency technology in the treatment of painful diseases, Chinese Association for the Study of Pain (CASP) has developed a consensus proposed by many domestic experts and scholars.     

脉冲射频和射频热凝术对臂丛神经损伤的病理学观察

目的探讨脉冲射频和射频热凝术致神经损伤的病理变化。方法 55只Wistar雄性大鼠,5只为正常对照组(C组),另50只暴露臂丛神经后随机分为脉冲射频组和射频热凝组,每组25只。在术后即刻、1、7、14和28 d取臂丛神行HE染色及透射电镜观察。结果脉冲射频组术后神经功能正常,光镜下可见神经纤维间出现水肿,于术后1 d最重,随后逐渐恢复。电镜下可见髓鞘板层结构松散,并有髓鞘球形成,及超微结构的代偿性增生,并逐渐恢复。射频热凝组术后神经功能消失,并出现自噬行为,镜下表现为沃勒变性和神经再生等改变。结论脉冲射频和射频热凝术对神经均可产生损伤。脉冲射频损伤轻微,且恢复快;射频热凝术则损伤严重,毁损神经恢复慢。     

Treatment of meralgia paresthetica with ultrasound-guided pulsed radiofrequency ablation of the lateral femoral cutaneous nerve

Abstract: A 23‐year‐old female with an 18‐month history of left anterolateral thigh paresthesias and burning pain consistent with meralgia paresthetica was referred to our clinic after failing trials of physical therapy, nonsteroidal anti‐inflammatories, gabapentin, and amitriptyline. We performed 3 lateral femoral cutaneous nerve blocks with corticosteroid over a 4‐month period; however, each block provided only temporary relief. As this pain was limiting the patient’s ability to perform her functions as an active duty service member, we elected to perform a pulsed radiofrequency treatment of the lateral femoral cutaneous nerve with ultrasound guidance and nerve stimulation. After locating the lateral femoral cutaneous nerve with ultrasound and reproducing the patient’s dysthesia with stimulation, pulsed radiofrequency treatment was performed at 42°C for 120 seconds. The needle was then rotated 180° and an additional cycle of pulsed radiofrequency treatment was performed followed by injection of 0.25% ropivacaine with 4 mg of dexamethasone. At 1.5 and 3 month follow‐up visits, the patient reported excellent pain relief with activity and improved ability to perform her duties as an active duty service member. ?     

Unsuccessful Pulsed Radiofrequency of the Sphenopalatine Ganglion in Patients with Chronic Cluster Headache and Subsequent Successful Thermocoagulation

We present the results of pulsed and continuous radiofrequency (CRF) of the sphenopalatine ganglion in a case series of 3 patients with chronic cluster headache (CCH). Three patients were referred to our neurosurgical department because of CCH, which was refractory to pharmacological treatment. They underwent pulsed radiofrequency of the sphenopalatine ganglion (PRF‐SPG), and the procedure was performed through an infrazygomatic approach. In the PRF procedures, we applied 2 cycles of PRF at 42°C and 45 V for 120 seconds, with a pulse frequency of 2 Hz and a pulse width of 20 ms. In those procedures where thermocoagulation was carried out, 2 CRF lesions at 80°C for 90 seconds each were performed. Following corticosteroid and local anesthetic (40 mg of methylprednisolone and 1 mL of 1% lidocaine) injection, 2 patients had no pain relief at all, whereas the third one experienced a partial response, which lasted only 1 month and his pain then returned to its baseline level. Thus, this outcome was assessed as a nonsustained partial response. Therefore, all of them underwent a CRF lesioning of the SPG, and after this procedure, they achieved complete pain relief until the end of the follow‐up period. Furthermore, the associated autonomic manifestations disappeared. The 3 patients presented in this case series failed to achieve adequate pain relief after PRF‐SPG. However, these same patients subsequently underwent a successful CRF of the SPG.     

Two Phase Radiofrequency Catheter Ablation of Isolated Ventricular Endomyocardium

This report describes a two phase radiofrequency (TPRF) energy source producing two radiofrequency sinusoidal voltages of similar frequency but different phase angles between three points of wire. When delivered through an orthogonal electrode catheter array (OECA) TPRF energy produces a square-shaped lesion of the area covered by the five electrodes (0.8 cm2). The purposes of the study were: to create square-shaped lesions using TPRF energy; to compare the size of lesions created by single phase radiofrequency (SPRF) to that of TPRF energy; and to study the depth of such lesions and to create lesions of desired size by adjacent placement of the OECA using TPRF energy. Ablations were created in nine isolated bovine hearts using three power settings (10, 20, and 40 watts) and three pulse durations (5, 10, and 20 seconds). Pathological examination was performed to document the length, width, depth, and the microscopic changes of ablations. TPRF energy increases the size of lesion (P less than 0.001) and utilizes less power (P less than 0.008) at the same power setting and pulse duration compared to SPRF energy. This is possibly related to earlier rise in impedance with TPRF compared to SPRF ablations. The largest lesion for both SPRF (0.51 +/- 0.08 cm2) and TPRF (1.03 +/- 0.18 cm2) ablations were observed at 20 watts for 20 seconds. By adjacent placement of the OECA and TPRF energy desired size (6 cm2) lesions were created. There was no significant difference between the depth of SPRF versus TPRF ablations at comparable power setting and pulse duration. Pathological examination revealed the shape of lesions were elliptical or cross-shaped for SPRF and square for TPRF ablations. Microscopic examination revealed coagulation necrosis, edema, and few necrotic cardiac muscle strands. Conclusions: TPRF energy can cause 1.2 cm2 lesions. TPRF compared to SPRF energy causes larger lesions but depth of lesions are not different than SPRF energy at the same power setting and pulse duration. By adjacent placement of OECA and TPRF energy desired size lesion can be created (6 cm2).     

Chronic Left Main Coronary Artery Occlusion: A Complication of Radiofrequency Ablation of Idiopathic Left Ventricular Tachycardia

We describe in this report the development of chronic left main coronary artery (LMCA) occlusion in a young patient 2 years after an uncomplicated, successful ablation of idiophic left ventricular tachycardia. This complication appears to be a late consequence of trauma to the LMCA during the procedure rather than an acute or subacute embolic event.     

Sphenopalatine Ganglion Pulsed Radiofrequency Treatment in 30 Patients Suffering from Chronic Face and Head Pain

Abstract:   This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and face pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of pain relief, and the presence of residual symptoms. Secondary objectives included the evaluation of adverse effects and complications. All data were derived from patient charts, phone conversations, and clinical follow-up visits. Fourteen percent of respondents reported no pain relief, 21% had complete pain relief, and 65% of the patients reported mild to moderate pain relief from SPG-PRF treatment. Sixty-five percent of the respondents reported mild to moderate reduction in oral opioids. None of the patients developed significant infection, bleeding, hematoma formation, dysesthesia, or numbness of palate, maxilla, or posterior pharynx. A large-scale study of SPG-PRF for the treatment of face and head pain has not been previously reported. Our results suggest that a prospective, randomized, controlled trial study to confirm efficacy and safety of this novel treatment for chronic head and face pain is justified.     

A randomized, prospective comparison of anterior and posterior approaches to atrioventricular junction modification of medically refractory atrial fibrillation

To compare the safety and efficacy of anterior versus posterior approach for atrioventricular (AV) junction modification, 40 patients with medically refractory paroxysmal (PAF) or chronic atrial fibrillation (AF) were randomly assigned to receive AV junction modification with an anterior or posterior approach. If the ablation session had taken more than 1 hour without success, the alternative ablation approach was attempted. Among the 18 patients assigned to receive the anterior approach, 14 (78%) had a primary success. One (5%) patient had complete AV block after ablation. Three patients crossed over to the posterior approach and had a successful outcome. Fourteen (64%) of 22 patients initially treated with the posterior approach had primary success. One (4%) patient developed complete AV block. Seven patients crossed over to the anterior approach and had a successful outcome. The primary success rate (14/18 vs 14/22, P = NS), incidence of transient AV block (3/18 vs 3/22, P = NS), and complete AV block (1/18 vs 1/22, P = NS) were similar between the anterior approach and posterior approach. The major differences between the two groups showed more radiofrequency pulses (10 +/- 4 vs 6 +/- 3 pulses, P < 0.01), longer procedure duration (50 +/- 24 vs 28 +/- 18 minutes, P < 0.01), and longer fluoroscopy exposure time (28 +/- 17 vs 16 +/- 8 minutes, P < 0.01) in the patients who had primary success with the posterior approach. In conclusion, this study demonstrated that (1) the two techniques had similar efficacies; (2) if one approach was ineffective, switching to the other approach might be safe; (3) combining these two approaches resulted in overall improvement in the success rate of this procedure, and (4) the posterior approach needed more radiofrequency pulses, longer procedural time, and longer fluoroscopy exposure time.     

Empirical pulmonary vein isolation in patients with chronic atrial fibrillation using a three-dimensional nonfluoroscopic mapping system: long-term follow-up

The purpose of this study was to assess the feasibility and long-term results of empirical isolation of both superior pulmonary veins in patients with chronic AF. Although localizing and ablating the focal triggers of AF has been proven an effective approach, this strategy is time consuming, often requires multiple procedures, and carries the risk of pulmonary vein stenosis. Whether ostial electrical isolation of the superior pulmonary veins, without initial detailed mapping, is a more efficient approach is not known. The study included 71 consecutive patients who had chronic AF. Using a nonfluoroscopic electroanatomic mapping system, the left and right superior pulmonary veins were ablated circumferentially at the venoatrial junction, with the aim of achieving electrical isolation of the veins. Following ablation, if frequent atrial ectopies were present, mapping and ablation were considered. The patients were periodically followed with 48-hour Holter and loop recorder monitoring. After the ablation of the right and left superior pulmonary veins 59 (83%) of 71 patients maintained sinus rhythm without premature atrial beats. The remaining 12 patients underwent further mapping and ablation including 5 patients who required isolation of the left inferior pulmonary veins. True electrical isolation could be achieved only in 45 (31%) of the 147 targeted veins. At the latest follow-up (mean 29 +/- 8 months), 80% of the patients with upper vein isolation remained in sinus rhythm off medications, 62% of the patients maintained sinus rhythm on previously ineffective medications, and 17% continued to be in AF. Fourteen (20%) patients developed intermittent episodes of left atrial flutter, and mapping in these patients revealed large electrically silent areas in the left atrium. Empirical isolation of pulmonary veins appeared to be an effective approach to help maintain sinus rhythm in patients with chronic AF. True electrical isolation of the pulmonary veins was associated with a higher likelihood of long-term success. Left atrial flutter was seen in a significant number of patients at long-term follow-up.