Circulation. 2001;104:2539-2544
doi: 10.1161/hc4601.098517
doi: 10.1161/hc4601.098517
(Circulation. 2001;104:2539.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Atrial Electroanatomic Remodeling After Circumferential Radiofrequency Pulmonary Vein Ablation
Efficacy of an Anatomic Approach in a Large Cohort of Patients With Atrial Fibrillation
From the Department of Cardiology, San Raffaele University Hospital, Milan, Italy; and the Department of Cardiology, University of Messina, Messina, Italy (G.O., M.P.C., E.F.).
Correspondence to Dr Carlo Pappone, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail carlo.pappone{at}hsr.it
Background Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently been described as a new anatomic approach for atrial fibrillation (AF).
Methods and Results We treated 251 consecutive patients with paroxysmal (n=179) or permanent (n=72) AF. Circular PV lesions were deployed transseptally during sinus rhythm (n=124) or AF (n=127) using 3D electroanatomic guidance. Procedures lasted 148±26 minutes. Among 980 lesions surrounding individual PVs (n=956) or 2 ipsilateral veins with close openings or common ostium (n=24), 75% were defined as complete by a bipolar electrogram amplitude <0.1 mV inside the lesion and a delay >30 ms across the line. The amount of low-voltage encircled area was 3594±449 mm2, which accounted for 23±9% of the total left atrial (LA) map surface. Major complications (cardiac tamponade) occurred in 2 patients (0.8%). No PV stenoses were detected by transesophageal echocardiography. After 10.4±4.5 months, 152 patients with paroxysmal AF (85%) and 49 with permanent AF (68%) were AF-free. Patients with and without AF recurrence did not differ in age, AF duration, prevalence of heart disease, or ejection fraction, but the LA diameter was significantly higher (P<0.001) in permanent AF patients with recurrence. The proportion of PVs with complete lesions was similar between patients with and without recurrence, but the latter had larger low-voltage encircled areas after radiofrequency (expressed as percent of LA surface area; P<0.001).
Conclusions Circumferential PV ablation is a safe and effective treatment for AF. Its success is likely due to both PV trigger isolation and electroanatomic remodeling of the area encompassing the PV ostia.
Key Words: arrhythmia • ablation • fibrillation • mapping
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G. Stabile, E. Bertaglia, G. Senatore, A. De Simone, F. Zoppo, G. Donnici, P. Turco, P. Pascotto, M. Fazzari, and D. F. Vitale Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study) Eur. Heart J., January 2, 2006; 27(2): 216 - 221. [Abstract] [Full Text] [PDF]
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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]
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A. V. Sarabanda, T. J. Bunch, S. B. Johnson, S. Mahapatra, M. A. Milton, L. R. Leite, G. K. Bruce, and D. L. Packer Efficacy and Safety of Circumferential Pulmonary Vein Isolation Using a Novel Cryothermal Balloon Ablation System J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1902 - 1912. [Abstract] [Full Text] [PDF]
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F. Ouyang, S. Ernst, J. Chun, D. Bansch, Y. Li, A. Schaumann, H. Mavrakis, X. Liu, F. T. Deger, B. Schmidt, et al. Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique Circulation, November 15, 2005; 112(20): 3038 - 3048. [Abstract] [Full Text] [PDF]
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W. P. Beukema, A. Elvan, H. T. Sie, A. R. Ramdat Misier, and H. J.J. Wellens Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size Circulation, October 4, 2005; 112(14): 2089 - 2095. [Abstract] [Full Text] [PDF]
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S.-H. Lee, C.-T. Tai, M.-H. Hsieh, H.-M. Tsao, Y.-J. Lin, S.-L. Chang, J.-L. Huang, K.-T. Lee, Y.-J. Chen, J.-J. Cheng, et al. Predictors of Non-Pulmonary Vein Ectopic Beats Initiating Paroxysmal Atrial Fibrillation: Implication for Catheter Ablation J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1054 - 1059. [Abstract] [Full Text] [PDF]
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D. Sanchez-Quintana, J. A. Cabrera, V. Climent, J. Farre, M. C. de Mendonca, and S. Y. Ho Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation Circulation, September 6, 2005; 112(10): 1400 - 1405. [Abstract] [Full Text] [PDF]
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B. J. Padanilam and E. N. Prystowsky Should Ablation Be First-Line Therapy and for Whom: The Antagonist Position Circulation, August 23, 2005; 112(8): 1223 - 1231. [Full Text] [PDF]
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A. Verma, F. Kilicaslan, E. Pisano, N. F. Marrouche, R. Fanelli, J. Brachmann, J. Geunther, D. Potenza, D. O. Martin, J. Cummings, et al. Response of Atrial Fibrillation to Pulmonary Vein Antrum Isolation Is Directly Related to Resumption and Delay of Pulmonary Vein Conduction Circulation, August 2, 2005; 112(5): 627 - 635. [Abstract] [Full Text] [PDF]
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H. Tanner, G. Hindricks, R. Kobza, A. Dorszewski, P. Schirdewahn, C. Piorkowski, J.-H. Gerds-Li, and H. Kottkamp Trigger Activity More Than Three Years After Left Atrial Linear Ablation Without Pulmonary Vein Isolation in Patients With Atrial Fibrillation J. Am. Coll. Cardiol., July 19, 2005; 46(2): 338 - 343. [Abstract] [Full Text] [PDF]
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T. Arentz, R. Weber, N. Jander, G. Burkle, J. von Rosenthal, T. Blum, J. Stockinger, L. Haegeli, F. J. Neumann, and D. Kalusche Pulmonary haemodynamics at rest and during exercise in patients with significant pulmonary vein stenosis after radiofrequency catheter ablation for drug resistant atrial fibrillation Eur. Heart J., July 2, 2005; 26(14): 1410 - 1414. [Abstract] [Full Text] [PDF]
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E. Bugge, I. A. Nicholson, and S. P. Thomas Comparison of bipolar and unipolar radiofrequency ablation in an in vivo experimental model Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 76 - 80. [Abstract] [Full Text] [PDF]
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B. J. Scherlag, W. Yamanashi, U. Patel, R. Lazzara, and W. M. Jackman Autonomically Induced Conversion of Pulmonary Vein Focal Firing Into Atrial Fibrillation J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1878 - 1886. [Abstract] [Full Text] [PDF]
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D. J. Callans Comparing Different Strategies for Catheter Ablation of Atrial Fibrillation Circulation, June 7, 2005; 111(22): 2866 - 2868. [Full Text] [PDF]
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M. R. Karch, B. Zrenner, I. Deisenhofer, J. Schreieck, G. Ndrepepa, J. Dong, K. Lamprecht, P. Barthel, E. Luciani, A. Schomig, et al. Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation: A Randomized Comparison Between 2 Current Ablation Strategies Circulation, June 7, 2005; 111(22): 2875 - 2880. [Abstract] [Full Text] [PDF]
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M. Hocini, P. Sanders, P. Jais, L.-F. Hsu, R. Weerasoriya, C. Scavee, Y. Takahashi, M. Rotter, F. Raybaud, L. Macle, et al. Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins Eur. Heart J., April 1, 2005; 26(7): 696 - 704. [Abstract] [Full Text] [PDF]
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