on October 13, 2003
Circulation. 2003
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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Submitted on June 23, 2003
From the Division of Cardiology, University of Michigan, Ann Arbor. * To whom correspondence should be addressed. E-mail: oralh{at}umich.edu.
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.
Revised on August 11, 2003
Accepted on August 13, 2003
Catheter Ablation for Paroxysmal Atrial Fibrillation. Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation
Hakan Oral MD*,
Key words: fibrillation • catheter ablation • veins • lung • atrium
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M. Mansour Highest Dominant Frequencies in Atrial Fibrillation: A New Target for Ablation? J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1408 - 1409. [Full Text] [PDF]
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A. Chugh, R. Latchamsetty, H. Oral, D. Elmouchi, D. Tschopp, S. Reich, P. Igic, T. Lemerand, E. Good, F. Bogun, et al. Characteristics of Cavotricuspid Isthmus-Dependent Atrial Flutter After Left Atrial Ablation of Atrial Fibrillation Circulation, February 7, 2006; 113(5): 609 - 615. [Abstract] [Full Text] [PDF]
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G. Stabile, E. Bertaglia, G. Senatore, A. De Simone, F. Zoppo, G. Donnici, P. Turco, P. Pascotto, M. Fazzari, and D. F. Vitale Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study) Eur. Heart J., January 2, 2006; 27(2): 216 - 221. [Abstract] [Full Text] [PDF]
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V. Essebag, J. V. Wylie, and M. E. Josephson Effectiveness of catheter ablation of atrial fibrillation Eur. Heart J., January 2, 2006; 27(2): 130 - 131. [Full Text] [PDF]
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A. M. Gillinov, F. Bakaeen, P. M. McCarthy, E. H. Blackstone, J. Rajeswaran, G. Pettersson, J. F. Sabik III, F. Najam, K. M. Hill, L. G. Svensson, et al. Surgery for Paroxysmal Atrial Fibrillation in the Setting of Mitral Valve Disease: A Role for Pulmonary Vein Isolation? Ann. Thorac. Surg., January 1, 2006; 81(1): 19 - 28. [Abstract] [Full Text] [PDF]
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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]
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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]
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F R Quinn and A C Rankin Atrial fibrillation ablation in the real world Heart, December 1, 2005; 91(12): 1507 - 1508. [Abstract] [Full Text] [PDF]
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J Pontoppidan, J C Nielsen, S H Poulsen, P T Mortensen, A K Pedersen, H K Jensen, and P S Hansen Radiofrequency ablation of atrial fibrillation: effectiveness and safety in 102 consecutive patients Heart, December 1, 2005; 91(12): 1611 - 1612. [Full Text] [PDF]
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W. P. Beukema, A. Elvan, H. T. Sie, A. R. Ramdat Misier, and H. J.J. Wellens Successful Radiofrequency Ablation in Patients With Previous Atrial Fibrillation Results in a Significant Decrease in Left Atrial Size Circulation, October 4, 2005; 112(14): 2089 - 2095. [Abstract] [Full Text] [PDF]
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S.-H. Lee, C.-T. Tai, M.-H. Hsieh, H.-M. Tsao, Y.-J. Lin, S.-L. Chang, J.-L. Huang, K.-T. Lee, Y.-J. Chen, J.-J. Cheng, et al. Predictors of Non-Pulmonary Vein Ectopic Beats Initiating Paroxysmal Atrial Fibrillation: Implication for Catheter Ablation J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1054 - 1059. [Abstract] [Full Text] [PDF]
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K. Lemola, H. Oral, A. Chugh, B. Hall, P. Cheung, J. Han, K. Tamirisa, E. Good, F. Bogun, F. Pelosi Jr, et al. Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1060 - 1066. [Abstract] [Full Text] [PDF]
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D. Sanchez-Quintana, J. A. Cabrera, V. Climent, J. Farre, M. C. de Mendonca, and S. Y. Ho Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation Circulation, September 6, 2005; 112(10): 1400 - 1405. [Abstract] [Full Text] [PDF]
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R. K. Wolf, E. W. Schneeberger, R. Osterday, D. Miller, W. Merrill, J. B. Flege Jr, and A. M. Gillinov Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 797 - 802. [Abstract] [Full Text] [PDF]
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A. Verma, A. Natale, B. J. Padanilam, E. N. Prystowsky, A. Verma, A. Natale, B. J. Padanilam, and E. N. Prystowsky Why Atrial Fibrillation Ablation Should Be Considered First-Line Therapy for Some Patients Circulation, August 23, 2005; 112(8): 1214 - 1222. [Full Text] [PDF]
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B. J. Padanilam and E. N. Prystowsky Should Ablation Be First-Line Therapy and for Whom: The Antagonist Position Circulation, August 23, 2005; 112(8): 1223 - 1231. [Full Text] [PDF]
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A. Verma, F. Kilicaslan, E. Pisano, N. F. Marrouche, R. Fanelli, J. Brachmann, J. Geunther, D. Potenza, D. O. Martin, J. Cummings, et al. Response of Atrial Fibrillation to Pulmonary Vein Antrum Isolation Is Directly Related to Resumption and Delay of Pulmonary Vein Conduction Circulation, August 2, 2005; 112(5): 627 - 635. [Abstract] [Full Text] [PDF]
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