Response to Letter Regarding Article, “Small or Large Isolation Areas Around the Pulmonary Veins for the Treatment of Atrial Fibrillation? Results From a Prospective Randomized Study”
In their letter regarding our article,1 Drs Kriatselis and Roser suggest that large isolation during circumferential ablation can only be proved using 2 circumferential mapping catheters, 1 in each ipsilateral pulmonary vein.
We agree that the double-Lasso technique2 allows us to know whether the disappearance of electrical potentials in both veins has been simultaneous. From a practical point of view, however, sequential mapping of both ipsilateral pulmonary veins will lead to the same ablation result, with elimination of all potentials in a large area. In addition, the use of 1 circumferential mapping catheter with variable diameter, as described in our study,1 permits mapping closer to the ablation line, probably improving the localization of conduction gaps.
It might be interesting, though, to compare the recurrence rates of atrial fibrillation and atrial flutter in patients who had simultaneous disappearance of potentials in both ipsilateral veins and in patients who did not.
Arentz T, Weber R, Bürkle G, Herrera C, Blum T, Stockinger J, Minners J, Neumann FJ, Kalusche D. Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation. 2007; 115: 3057–3063.
Ouyang F, Bänsch D, Ernst S, Schaumann S, Hachiya H, Chen M, Chun J, Falk P, Khanedani A, Antz M, Kuck KH. Complete isolation of the left atrium surrounding the pulmonary veins: new insights from the double Lasso technique in paroxysmal atrial fibrillation. Circulation. 2004; 110: 2090–2096.