Circulation. 2003;108:2355-2360
Published online before print October 13, 2003, doi: 10.1161/01.CIR.0000095796.45180.88
Published online before print October 13, 2003, doi: 10.1161/01.CIR.0000095796.45180.88
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(Circulation. 2003;108:2355.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Catheter Ablation for Paroxysmal Atrial Fibrillation
Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation
From the Division of Cardiology, University of Michigan, Ann Arbor.
Correspondence to Hakan Oral, MD, Cardiology, TC B1 140D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0311. E-mail oralh{at}umich.edu
Received June 23, 2003; revision received August 11, 2003; accepted August 13, 2003.
Background— Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared.
Methods and Results— Of 80 consecutive patients with symptomatic PAF (age, 52±10 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left- and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 156±45 and 50±17 minutes for SOCA and 149±33 and 39±12 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of symptomatic PAF when not taking antiarrhythmic drug therapy (P=0.02). Among the variables of age, sex, duration and frequency of PAF, ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size and the SOCA technique were independent predictors of recurrent PAF. The only complication was left atrial flutter in a patient who underwent LACA.
Conclusions— In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA.
Key Words: fibrillation • catheter ablation • veins • lung • atrium
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