Circulation. 2004;110:2996-3002
Published online before print November 1, 2004, doi: 10.1161/01.CIR.0000146917.75041.58
Published online before print November 1, 2004, doi: 10.1161/01.CIR.0000146917.75041.58
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;110:2996-3002.)
© 2004 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Technique and Results of Linear Ablation at the Mitral Isthmus
From Hôpital Haut-Lévèque, Université Bordeaux II Victor Segalen, Bordeaux-Pessac, France.
Correspondence to Docteur Pierre Jaïs, Hôpital Haut-Lévêque, 33604 Bordeaux-Pessac, France. E-mail pierre.jais{at}chu-bordeaux.fr
Received April 17, 2003; de novo received February 6, 2004; revision received May 26, 2004; accepted June 10, 2004.
Background— This prospective clinical study evaluates the feasibility and efficacy of combined linear mitral isthmus ablation and pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF).
Methods and Results— One hundred consecutive patients (13 women; age 55±10 years) with drug-refractory, symptomatic paroxysmal AF underwent PV isolation and linear ablation of the cavotricuspid isthmus and the mitral isthmus (lateral mitral annulus to the left inferior PV). They were compared with 100 consecutive patients (14 women; age, 52±10 years) undergoing PV isolation and cavotricuspid ablation without mitral isthmus ablation. Bidirectional mitral isthmus block was confirmed by demonstrating (1) a parallel corridor of double potentials during coronary sinus (CS) pacing, (2) an activation detour by pacing either side of the line, and (3) differential pacing techniques. Isolation of all PVs and cavotricuspid isthmus ablation were performed successfully in all. Mitral isthmus block was achieved in 92 patients after 20±10 minutes of endocardial radiofrequency application and an additional 5±4 minutes of epicardial radiofrequency application from within the CS in 68, resulting in a conduction delay of 151±26 ms during CS pacing. Thirty-two patients with mitral isthmus ablation compared with 49 without had recurrent atrial arrhythmia (P=0.02) requiring further ablation. At 1 year after the last procedure, 87 patients with mitral isthmus ablation and 69 without (P=0.002) were arrhythmia free without antiarrhythmic drugs, mitral isthmus ablation being the only factor associated with long-term success (RR for AF recurrence, 0.2; CI, 0.1 to 0.4; P<0.001).
Conclusions— Catheter ablation of the mitral isthmus results consistently in demonstrable conduction block and is associated with a high cure rate for paroxysmal AF.
Key Words: atrium • fibrillation • catheter ablation
This article has been cited by other articles:
 |
|
 |
|
  S. Miyazaki, T. Kuwahara, A. Kobori, Y. Takahashi, A. Takei, A. Sato, M. Isobe, and A. Takahashi Pharmacological cardioversion preceding left atrial ablation: bepridil predicts the clinical outcome following ablation in patients with persistent atrial fibrillation Europace, December 1, 2009; 11(12): 1620 - 1623. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bertaglia, C. Tondo, A. De Simone, F. Zoppo, M. Mantica, P. Turco, A. Iuliano, G. Forleo, V. La Rocca, and G. Stabile Does catheter ablation cure atrial fibrillation? Single-procedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicentre experience Europace, November 3, 2009; (2009) eup349v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Edgerton, W. M. Jackman, and M. J. Mack A new epicardial lesion set for minimal access left atrial maze: the dallas lesion set. Ann. Thorac. Surg., November 1, 2009; 88(5): 1655 - 1657. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. CHOWDHURY, W. R. LEWIS, R. A. SCHWEIKERT, and J. E. CUMMINGS Ablation of atrial fibrillation: What can we tell our patients? Cleveland Clinic Journal of Medicine, September 1, 2009; 76(9): 543 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Terasawa, E. M. Balk, M. Chung, A. C. Garlitski, A. A. Alsheikh-Ali, J. Lau, and S. Ip Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Ann Intern Med, August 4, 2009; 151(3): 191 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Bencsik, M. Martinek, S. Hassanein, J. Aichinger, H.-J. Nesser, and H. Purerfellner Acute effects of complex fractionated atrial electrogram ablation on dominant frequency and regulatory index for the fibrillatory process Europace, August 1, 2009; 11(8): 1011 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation' Europace, July 1, 2009; 11(7): 860 - 885. [Full Text] [PDF]
|
|
|
|
|
|
S. Takatsuki, F. Extramiana, M. Hayashi, A. Haggui, A. Messali, P. Milliez, A. Leenhardt, and B. Cauchemez High take-off left inferior pulmonary vein as an obstacle in creating a conduction block at the lateral mitral isthmus Europace, July 1, 2009; 11(7): 910 - 916. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. O'Neill, M. Wright, S. Knecht, P. Jais, M. Hocini, Y. Takahashi, A. Jonsson, F. Sacher, S. Matsuo, K. T. Lim, et al. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint Eur. Heart J., May 1, 2009; 30(9): 1105 - 1112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Di Biase, L. C. Saenz, D. J. Burkhardt, M. Vacca, C. S. Elayi, C. D. Barrett, R. Horton, R. Bai, A. Siu, T. S. Fahmy, et al. Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation: Documented Higher Risk of Luminal Esophageal Damage With General Anesthesia as Compared With Conscious Sedation Circ Arrhythm Electrophysiol, April 1, 2009; 2(2): 108 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Schmidt, R. R. Tilz, K. Neven, K.R. Julian Chun, A. Furnkranz, and F. Ouyang Remote Robotic Navigation and Electroanatomical Mapping for Ablation of Atrial Fibrillation: Considerations for Navigation and Impact on Procedural Outcome Circ Arrhythm Electrophysiol, April 1, 2009; 2(2): 120 - 128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Di Biase, C. S. Elayi, T. S. Fahmy, D. O. Martin, C. K. Ching, C. Barrett, R. Bai, D. Patel, Y. Khaykin, R. Hongo, et al. Atrial Fibrillation Ablation Strategies for Paroxysmal Patients: Randomized Comparison Between Different Techniques Circ Arrhythm Electrophysiol, April 1, 2009; 2(2): 113 - 119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Tamborero, L. Mont, A. Berruezo, M. Matiello, B. Benito, M. Sitges, B. Vidal, T. M. de Caralt, R. J. Perea, R. Vatasescu, et al. Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective Randomized Study Circ Arrhythm Electrophysiol, February 1, 2009; 2(1): 35 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Wang, X. Meng, H. Li, Y. Cui, J. Han, and C. Xu Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 116 - 122. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Camm, P. Kirchhof, G. Y.H. Lip, I. Savelieva, and S. Ernst CHAPTER 29 Atrial Fibrillation ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Jais, B. Cauchemez, L. Macle, E. Daoud, P. Khairy, R. Subbiah, M. Hocini, F. Extramiana, F. Sacher, P. Bordachar, et al. Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: The A4 Study Circulation, December 9, 2008; 118(24): 2498 - 2505. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rostock, D. Steven, B. Hoffmann, H. Servatius, I. Drewitz, K. Sydow, K. Mullerleile, R. Ventura, K. Wegscheider, T. Meinertz, et al. Chronic Atrial Fibrillation Is a Biatrial Arrhythmia: Data from Catheter Ablation of Chronic Atrial Fibrillation Aiming Arrhythmia Termination Using a Sequential Ablation Approach Circ Arrhythm Electrophysiol, December 1, 2008; 1(5): 344 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Chiribiri, S. Kelle, U. Kohler, L. F. Tops, B. Schnackenburg, R. Bonamini, J. J. Bax, E. Fleck, and E. Nagel Magnetic resonance cardiac vein imaging: relation to mitral valve annulus and left circumflex coronary artery. J. Am. Coll. Cardiol. Img., November 1, 2008; 1(6): 729 - 738. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gaita, D. Caponi, M. Scaglione, A. Montefusco, A. Corleto, F. Di Monte, D. Coin, P. Di Donna, and C. Giustetto Long-Term Clinical Results of 2 Different Ablation Strategies in Patients With Paroxysmal and Persistent Atrial Fibrillation Circ Arrhythm Electrophysiol, October 1, 2008; 1(4): 269 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Ishii, T. Nitta, M. Kambe, J. Kurita, M. Ochi, Y. Miyauchi, and K. Shimizu Intraoperative verification of conduction block in atrial fibrillation surgery. J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 998 - 1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Knecht, M. Hocini, M. Wright, N. Lellouche, M. D. O'Neill, S. Matsuo, I. Nault, V. S. Chauhan, K. J. Makati, M. Bevilacqua, et al. Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation Eur. Heart J., October 1, 2008; 29(19): 2359 - 2366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Aliot and J. N. Ruskin Controversies in ablation of atrial fibrillation Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H32 - H54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Neumann, J. Vogt, B. Schumacher, A. Dorszewski, M. Kuniss, H. Neuser, K. Kurzidim, A. Berkowitsch, M. Koller, J. Heintze, et al. Circumferential Pulmonary Vein Isolation With the Cryoballoon Technique: Results From a Prospective 3-Center Study J. Am. Coll. Cardiol., July 22, 2008; 52(4): 273 - 278. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Ghavidel, H. Javadpour, M. Shafiee, M.-B. Tabatabaie, K. Raiesi, and S. Hosseini Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1043 - 1048. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. W. Lim, C. H. Koay, R. McCall, V. A. See, D. L. Ross, and S. P. Thomas Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation: Mechanisms and Management Circ Arrhythm Electrophysiol, June 1, 2008; 1(2): 120 - 126. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Benussi, S. Nascimbene, A. Galanti, A. Fumero, E. Dorigo, V. Zerbi, M. Cioni, and O. Alfieri Complete left atrial ablation with bipolar radiofrequency Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 590 - 595. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Takahashi, M. D. O'Neill, M. Hocini, R. Dubois, S. Matsuo, S. Knecht, S. Mahapatra, K.-T. Lim, P. Jais, A. Jonsson, et al. Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 1003 - 1010. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. E. Marchlinski Atrial fibrillation catheter ablation: learning by burning continues. J. Am. Coll. Cardiol., March 11, 2008; 51(10): 1011 - 1013. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Gillinov Choice of Surgical Lesion Set: Answers From the Data Ann. Thorac. Surg., November 1, 2007; 84(5): 1786 - 1792. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haissaguerre, K.-T. Lim, V. Jacquemet, M. Rotter, L. Dang, M. Hocini, S. Matsuo, S. Knecht, P. Jais, and N. Virag Atrial fibrillatory cycle length: computer simulation and potential clinical importance Europace, November 1, 2007; 9(suppl_6): vi64 - vi70. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Saremi and S. Krishnan Cardiac Conduction System: Anatomic Landmarks Relevant to Interventional Electrophysiologic Techniques Demonstrated with 64-Detector CT RadioGraphics, November 1, 2007; 27(6): 1539 - 1565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Chae, H. Oral, E. Good, S. Dey, A. Wimmer, T. Crawford, D. Wells, J.-F. Sarrazin, N. Chalfoun, M. Kuhne, et al. Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation: Mechanistic Insights, Results of Catheter Ablation, and Risk Factors for Recurrence J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1781 - 1787. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre Catheter Ablation for Atrial Fibrillation Circulation, September 25, 2007; 116(13): 1515 - 1523. [Full Text] [PDF]
|
|
|
|
|
|
S.-L. Chang, C.-T. Tai, Y.-J. Lin, W. Wongcharoen, L.-W. Lo, K.-T. Lee, S.-H. Chang, T.-C. Tuan, Y.-J. Chen, M.-H. Hsieh, et al. The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation J. Am. Coll. Cardiol., September 4, 2007; 50(10): 964 - 973. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]
|
|
|
|
|
|
Y. Takahashi, M. D. O'Neill, M. Hocini, P. Reant, A. Jonsson, P. Jais, P. Sanders, T. Rostock, M. Rotter, F. Sacher, et al. Effects of Stepwise Ablation of Chronic Atrial Fibrillation on Atrial Electrical and Mechanical Properties J. Am. Coll. Cardiol., March 27, 2007; 49(12): 1306 - 1314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Gillinov, S. Bhavani, E. H. Blackstone, J. Rajeswaran, L. G. Svensson, J. L. Navia, B.G. Pettersson, J. F. Sabik III, N. G. Smedira, T. Mihaljevic, et al. Surgery for Permanent Atrial Fibrillation: Impact of Patient Factors and Lesion Set Ann. Thorac. Surg., August 1, 2006; 82(2): 502 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Calo, F. Lamberti, M. L. Loricchio, E. De Ruvo, F. Colivicchi, L. Bianconi, C. Pandozi, and M. Santini Left Atrial Ablation Versus Biatrial Ablation for Persistent and Permanent Atrial Fibrillation: A Prospective and Randomized Study J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2504 - 2512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Takahashi, M. Hocini, M. D. O'Neill, P. Sanders, M. Rotter, T. Rostock, A. Jonsson, F. Sacher, J. Clementy, P. Jais, et al. Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2005 - 2012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hocini, P. Jais, P. Sanders, Y. Takahashi, M. Rotter, T. Rostock, L.-F. Hsu, F. Sacher, S. Reuter, J. Clementy, et al. Techniques, Evaluation, and Consequences of Linear Block at the Left Atrial Roof in Paroxysmal Atrial Fibrillation: A Prospective Randomized Study Circulation, December 13, 2005; 112(24): 3688 - 3696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sanders, M. Hocini, P. Jais, L.-F. Hsu, Y. Takahashi, M. Rotter, C. Scavee, J.-L. Pasquie, F. Sacher, T. Rostock, et al. Characterization of Focal Atrial Tachycardia Using High-Density Mapping J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2088 - 2099. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Essebag, F. Baldessin, M. R. Reynolds, S. McClennen, J. Shah, K. F. Kwaku, P. Zimetbaum, and M. E. Josephson Non-inducibility post-pulmonary vein isolation achieving exit block predicts freedom from atrial fibrillation Eur. Heart J., December 1, 2005; 26(23): 2550 - 2555. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sanders, O. Berenfeld, M. Hocini, P. Jais, R. Vaidyanathan, L.-F. Hsu, S. Garrigue, Y. Takahashi, M. Rotter, F. Sacher, et al. Spectral Analysis Identifies Sites of High-Frequency Activity Maintaining Atrial Fibrillation in Humans Circulation, August 9, 2005; 112(6): 789 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chugh, H. Oral, E. Good, J. Han, K. Tamirisa, K. Lemola, D. Elmouchi, D. Tschopp, S. Reich, P. Igic, et al. Catheter Ablation of Atypical Atrial Flutter and Atrial Tachycardia Within the Coronary Sinus After Left Atrial Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., July 5, 2005; 46(1): 83 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Rotter, Y. Takahashi, P. Sanders, M. Haissaguerre, P. Jais, L.-F. Hsu, F. Sacher, J.-L. Pasquie, J. Clementy, and M. Hocini Reduction of fluoroscopy exposure and procedure duration during ablation of atrial fibrillation using a novel anatomical navigation system Eur. Heart J., July 2, 2005; 26(14): 1415 - 1421. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L.-F. Hsu, P. Jais, P. Sanders, S. Garrigue, M. Hocini, F. Sacher, Y. Takahashi, M. Rotter, J.-L. Pasquie, C. Scavee, et al. Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure N. Engl. J. Med., December 2, 2004; 351(23): 2373 - 2383. [Abstract] [Full Text] [PDF]
|
|