(Circulation. 1999;100:1203-1208.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Catheter Ablation of Paroxysmal Atrial Fibrillation Using a 3D Mapping System
From the Cardiology Department, Hospital S. Raffaele, Milan, Italy (C.P., F.L., G.V., M.L.L., M.R., A.C., S.C.); the Cardiology Department, University of Messina, Messina, Italy (G.O., M.P.C.); the Cardiovascular System Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (S.S., S.A.B.-H.); and the Allgemeines Krankenhaus St Georg, II Medizinische Abteilung, Hamburg, Germany (R.C.).
Correspondence to Carlo Pappone, MD, Divisione di Cardiologia, Ospedale S Raffaele, Via Olgettina, 60, 20132 Milano, Italy.
Background—We treated paroxysmal recurrent atrial fibrillation (AF) with radiofrequency (RF) catheter ablation by creating long linear lesions in the atria. To achieve line continuity, a 3D electroanatomic nonfluoroscopic mapping system was used.
Methods and Results—In 27 patients with recurrent AF, a catheter incorporating a passive magnetic field sensor was navigated in both atria to construct a 3D activation map. RF energy was delivered to create continuous linear lesions: 3 lines (intercaval, isthmic, and anteroseptal) in the right atrium and a long line encircling the pulmonary veins in the left atrium. After RF application, the atria were remapped to validate completeness of the block lines, demonstrated by late activation of the areas circumscribed by the lines. The mean procedure duration was 312±103 minutes (range, 187 to 495), with mean fluoroscopy time of 107±44 minutes (range, 32 to 185 minutes). No acute complications occurred, but 1 patient experienced early prolonged sinus pauses and received a pacemaker. During the first day, 17 patients (63%) had AF episodes, but at discharge, 25 patients were in sinus rhythm. After a follow-up of 6.0 to 15.3 months (average, 10.5±3.0 months), 16 patients are asymptomatic, 3 have an almost complete disappearance of symptoms, 1 patient is improved, and 7 patients have their AF attacks unchanged.
Conclusions—Paroxysmal recurrent drug-refractory AF can be treated by RF catheter ablation. Creation of long continuous linear lesions necessary to compartmentalize the atria is facilitated by a nonfluoroscopic electroanatomic mapping system.
Key Words: catheter ablation • fibrillation • mapping
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|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
H. Kottkamp, G. Hindricks, R.u. Autschbach, B. Krauss, B. Strasser, P. Schirdewahn, A. Fabricius, G. Schuler, and F.-W. Mohr Specific linear left atrial lesions in atrial fibrillation: Intraoperative radiofrequency ablation using minimally invasive surgical techniques J. Am. Coll. Cardiol., August 7, 2002; 40(3): 475 - 480. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gaita and R. Riccardi Lone atrial fibrillation ablation: Transcatheter or minimally invasive surgical approaches? J. Am. Coll. Cardiol., August 7, 2002; 40(3): 481 - 483. [Full Text] [PDF]
|
|
|
|
 |
|
 P. A Friedman Novel mapping techniques for cardiac electrophysiology Heart, June 1, 2002; 87(6): 575 - 582. [Full Text] [PDF]
|
|
|
|
 |
|
 F. W. Mohr, A. M. Fabricius, V. Falk, R. Autschbach, N. Doll, U. von Oppell, A. Diegeler, H. Kottkamp, and G. Hindricks Curative treatment of atrial fibrillation with intraoperative radiofrequency ablation: Short-term and midterm results J. Thorac. Cardiovasc. Surg., May 1, 2002; 123(5): 919 - 927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
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|
|
|
|
|
|
C. Pappone Atrial fibrillation--a curable condition? Eur. Heart J., April 1, 2002; 23(7): 514 - 517. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
K. Tanaka, S. Satake, S. Saito, S. Takahashi, Y. Hiroe, Y. Miyashita, S. Tanaka, M. Tanaka, and Y. Watanabe A new radiofrequency thermal balloon catheter for pulmonary vein isolation J. Am. Coll. Cardiol., December 1, 2001; 38(7): 2079 - 2086. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Pappone, G. Oreto, S. Rosanio, G. Vicedomini, M. Tocchi, F. Gugliotta, A. Salvati, C. Dicandia, M. P. Calabro, P. Mazzone, et al. Atrial Electroanatomic Remodeling After Circumferential Radiofrequency Pulmonary Vein Ablation: Efficacy of an Anatomic Approach in a Large Cohort of Patients With Atrial Fibrillation Circulation, November 20, 2001; 104(21): 2539 - 2544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gasparini, M. Mantica, F. Coltorti, P. Galimberti, and C. Ceriotti The use of advanced mapping systems to guide right linear lesions in paroxysmal atrial fibrillation Eur. Heart J. Suppl., November 1, 2001; 3(suppl_P): P41 - P46. [Abstract] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology Circulation, October 23, 2001; 104(17): 2118 - 2150. [Full Text] [PDF]
|
|
|
|
|
|
Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1231 - 1265. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]
|
|
|
|
|
|
M. M. Scheinman and F. Morady Nonpharmacological Approaches to Atrial Fibrillation Circulation, April 24, 2001; 103(16): 2120 - 2125. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Falk Atrial Fibrillation N. Engl. J. Med., April 5, 2001; 344(14): 1067 - 1078. [Full Text] [PDF]
|
|
|
|
|
|
C. Pappone, S. Rosanio, G. Oreto, M. Tocchi, F. Gugliotta, G. Vicedomini, A. Salvati, C. Dicandia, P. Mazzone, V. Santinelli, et al. Circumferential Radiofrequency Ablation of Pulmonary Vein Ostia : A New Anatomic Approach for Curing Atrial Fibrillation Circulation, November 21, 2000; 102(21): 2619 - 2628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haissaguerre, D. C. Shah, P. Jais, C. Pappone, F. Lamberti, G. Vicedomini, M. L. Loricchio, M. Rillo, A. Conversano, S. Chierchia, et al. Catheter-Mediated Linear Block in the Atria Response Circulation, October 31, 2000; 102 (18): e123 - e123. [Full Text] [PDF]
|
|