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(Circulation. 2008;117:127.)
© 2008 American Heart Association, Inc.
Clinical Summaries
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Radiofrequency Ablation of Atrial Fibrillation: Is the Persistence of All Intraprocedural Targets Necessary for Long-Term Maintenance of Sinus Rhythm? |
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Radiofrequency catheter ablation has emerged as an important therapeutic option in patients with drug-resistant atrial fibrillation. Different approaches have been tested, but specific intraprocedural targets and end points remain controversial. Demonstration that a particular procedural end point, such as conduction block into a pulmonary vein (PV), is critical requires the demonstration of persistence of that end point during follow-up. Recovery of ablation lesions is well reported, so the demonstration of persistence and relation of this to prevention of atrial fibrillation requires repeat electrophysiological study in asymptomatic patients after an effective ablation procedure. The aim of the present study was to verify the long-term result of encircling PV ablation with the end point of atrial potential abatement plus PV disconnection confirmed with a multipolar catheter. Repeat electrophysiology study was performed 2.5 years after successful ablation in a series of patients in stable sinus rhythm after previously persistent atrial fibrillation. These data were compared with those obtained from redo ablation procedures because of atrial fibrillation recurrences. In patients in stable sinus rhythm after ablation, only 37.5% of the PVs remained disconnected, and 60% of the PVs had recovered electrogram voltage within the ablation region. No statistically significant differences were noted between patients with and without recurrences after the initial ablation procedure. This study suggests that common intraprocedural end points such as voltage abatement and PV disconnection persist only in a limited number of patients, even when the outcome is favorable during follow-up. Further studies will be required to confirm these data in
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