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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