Published Online
on October 25, 2004

A more recent version of this article appeared on November 2, 2004

This Article Full Text (PDF) All Versions of this Article: 110/18/2797    most recent 01.CIR.0000146786.87037.26v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Oral, H. Articles by Morady, F. Search for Related Content PubMed PubMed Citation Articles by Oral, H. Articles by Morady, F. Related Collections Electrophysiology Arrhythmias, clinical electrophysiology, drugs Ablation/ICD/surgery

Submitted on June 1, 2004
Revised on July 28, 2004
Accepted on August 18, 2004

Noninducibility of Atrial Fibrillation as an End Point of Left Atrial Circumferential Ablation for Paroxysmal Atrial Fibrillation. A Randomized Study

Hakan Oral MD^*, Aman Chugh MD, Kristina Lemola MD, Peter Cheung MD, Burr Hall MD, Eric Good DO, Jihn Han MD, Kamala Tamirisa MD, Frank Bogun MD, Frank Pelosi Jr MD, and Fred Morady MD

From the Division of Cardiology, University of Michigan, Ann Arbor.

^* To whom correspondence should be addressed. E-mail: oralh{at}umich.edu.

Background--An anatomic approach of left atrial radiofrequency circumferential ablation (LACA) to encircle the pulmonary veins is often effective in eliminating paroxysmal atrial fibrillation (AF). However, no electrophysiological end points other than voltage abatement and/or conduction slowing or block across ablation lines have been used. It has been unclear whether noninducibility of AF is a clinically useful end point.

Methods and Results--In 100 patients with paroxysmal AF (mean age, 55±10 years), LACA to encircle the left- and right-sided pulmonary veins was performed during AF, with additional ablation lines in the posterior left atrium and mitral isthmus, with an 8-mm-tip catheter. After completion of this lesion set, sinus rhythm was present, and AF lasting >60 seconds was not inducible in 40 patients (40%; group 1). The 60 patients in whom AF was still present or who still had inducible AF were randomly assigned to no further ablation (group 2; 30 patients) or to additional ablation lines along the left atrial septum, roof, and/or anterior wall where there were fractionated electrograms (group 3; 30 patients). In group 3, AF was rendered noninducible in 27 of 30 patients (90%). At a 6-month follow-up, 67% of patients in group 2 were free of AF without drug therapy compared with 86% of patients in group 3. (P=0.05, log-rank test). Left atrial flutter occurred in 17% and 27% of patients in each group, respectively (P=0.3).

Conclusions--After LACA in patients with paroxysmal AF, AF usually can be rendered noninducible by additional ablation at sites of fractionated electrograms. Noninducibility of AF attained by additional electrogram-guided left atrial ablation may be associated with a better midterm clinical outcome than when AF is still inducible after LACA alone.

Key words: atrial fibrillation • atrium • catheter ablation

This article has been cited by other articles:

				S. Knecht, M. Hocini, M. Wright, N. Lellouche, M. D. O'Neill, S. Matsuo, I. Nault, V. S. Chauhan, K. J. Makati, M. Bevilacqua, et al. Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation Eur. Heart J., July 8, 2008; (2008) ehn302v1. [Abstract] [Full Text] [PDF]

				K. Satomi, R. Tilz, S. Takatsuki, J. Chun, B. Schmidt, D. Bansch, M. Antz, T. Zerm, A. Metzner, B. Kokturk, et al. Inducibility of atrial tachyarrhythmias after circumferential pulmonary vein isolation in patients with paroxysmal atrial fibrillation: clinical predictor and outcome during follow-up Europace, May 19, 2008; (2008) eun131v1. [Abstract] [Full Text] [PDF]

				H. Oral, A. Chugh, E. Good, T. Crawford, J. F. Sarrazin, M. Kuhne, N. Chalfoun, D. Wells, W. Boonyapisit, N. Gadeela, et al. Randomized Evaluation of Right Atrial Ablation After Left Atrial Ablation of Complex Fractionated Atrial Electrograms for Long-Lasting Persistent Atrial Fibrillation Circ Arrhythmia Electrophysiol, April 1, 2008; 1(1): 6 - 13. [Abstract] [Full Text] [PDF]

				K. C. Roberts-Thomson, I. H. Stevenson, P. M. Kistler, H. M. Haqqani, J. C. Goldblatt, P. Sanders, and J. M. Kalman Anatomically Determined Functional Conduction Delay in the Posterior Left Atrium: Relationship to Structural Heart Disease J. Am. Coll. Cardiol., February 26, 2008; 51(8): 856 - 862. [Abstract] [Full Text] [PDF]

				D. G. Katritsis and A. J. Camm Catheter ablation of atrial fibrillation: do we know what we are doing? Europace, November 1, 2007; 9(11): 1002 - 1005. [Full Text] [PDF]

				S. M. Narayan and M. R. Franz Quantifying fractionation and rate in human atrial fibrillation using monophasic action potentials: implications for substrate mapping Europace, November 1, 2007; 9(suppl_6): vi89 - vi95. [Abstract] [Full Text] [PDF]

				M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre Catheter Ablation for Atrial Fibrillation Circulation, September 25, 2007; 116(13): 1515 - 1523. [Full Text] [PDF]

				S.-L. Chang, C.-T. Tai, Y.-J. Lin, W. Wongcharoen, L.-W. Lo, K.-T. Lee, S.-H. Chang, T.-C. Tuan, Y.-J. Chen, M.-H. Hsieh, et al. The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation J. Am. Coll. Cardiol., September 4, 2007; 50(10): 964 - 973. [Abstract] [Full Text] [PDF]

				M. M. Scheinman and E. Keung The Year in Clinical Cardiac Electrophysiology J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2061 - 2069. [Full Text] [PDF]

				H. Oral, A. Chugh, E. Good, A. Wimmer, S. Dey, N. Gadeela, S. Sankaran, T. Crawford, J. F. Sarrazin, M. Kuhne, et al. Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms Circulation, May 22, 2007; 115(20): 2606 - 2612. [Abstract] [Full Text] [PDF]

				A. Berruezo, D. Tamborero, L. Mont, B. Benito, J. M. Tolosana, M. Sitges, B. Vidal, G. Arriagada, F. Mendez, M. Matiello, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation Eur. Heart J., April 1, 2007; 28(7): 836 - 841. [Abstract] [Full Text] [PDF]

				B. Richter, M. Gwechenberger, P. Filzmoser, M. Marx, P. Lercher, and H. D. Gossinger Is inducibility of atrial fibrillation after radio frequency ablation really a relevant prognostic factor? Eur. Heart J., November 1, 2006; 27(21): 2553 - 2559. [Abstract] [Full Text] [PDF]

				I. Deisenhofer, H. Estner, B. Zrenner, J. Schreieck, S. Weyerbrock, G. Hessling, K. Scharf, M. R. Karch, and C. Schmitt Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation. Europace, August 1, 2006; 8(8): 573 - 582. [Abstract] [Full Text] [PDF]

				L. Calo, F. Lamberti, M. L. Loricchio, E. De Ruvo, F. Colivicchi, L. Bianconi, C. Pandozi, and M. Santini Left Atrial Ablation Versus Biatrial Ablation for Persistent and Permanent Atrial Fibrillation: A Prospective and Randomized Study J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2504 - 2512. [Abstract] [Full Text] [PDF]

				Y. Takahashi, M. Hocini, M. D. O'Neill, P. Sanders, M. Rotter, T. Rostock, A. Jonsson, F. Sacher, J. Clementy, P. Jais, et al. Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2005 - 2012. [Abstract] [Full Text] [PDF]

				H. Oral, A. Chugh, E. Good, S. Sankaran, S. S. Reich, P. Igic, D. Elmouchi, D. Tschopp, T. Crawford, S. Dey, et al. A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation Circulation, April 18, 2006; 113(15): 1824 - 1831. [Abstract] [Full Text] [PDF]

				E. Good, H. Oral, K. Lemola, J. Han, K. Tamirisa, P. Igic, D. Elmouchi, D. Tschopp, S. Reich, A. Chugh, et al. Movement of the Esophagus During Left Atrial Catheter Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2107 - 2110. [Abstract] [Full Text] [PDF]

				V. Essebag, F. Baldessin, M. R. Reynolds, S. McClennen, J. Shah, K. F. Kwaku, P. Zimetbaum, and M. E. Josephson Non-inducibility post-pulmonary vein isolation achieving exit block predicts freedom from atrial fibrillation Eur. Heart J., December 1, 2005; 26(23): 2550 - 2555. [Abstract] [Full Text] [PDF]

				H. Heidbuchel Left atrial ablation pendulum swinging back towards the pulmonary veins Eur. Heart J., December 1, 2005; 26(23): 2484 - 2486. [Full Text] [PDF]

				M. M. Scheinman and E. Keung The year in clinical electrophysiology J. Am. Coll. Cardiol., March 1, 2005; 45(5): 790 - 795. [Full Text] [PDF]