Published Online
on December 27, 2004

A more recent version of this article appeared on January 18, 2005

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Submitted on June 14, 2004
Revised on October 11, 2004
Accepted on October 13, 2004

Linear Cryoablation of the Left Atrium Versus Pulmonary Vein Cryoisolation in Patients With Permanent Atrial Fibrillation and Valvular Heart Disease. Correlation of Electroanatomic Mapping and Long-Term Clinical Results

Fiorenzo Gaita MD^*, Riccardo Riccardi MD, Domenico Caponi MD, Dipen Shah MD, Lucia Garberoglio MD, Laura Vivalda MD, Alessandro Dulio BS, Andrea Chiecchio PhD, Eric Manasse MD, and Roberto Gallotti MD

From the Division of Cardiology, Ospedale Civile, Asti (G.F., R.R., C.D., S.D., G.L., V.L., D.A., C.A.), and Unità Operativa di Cardiochirurgia, Istituto Clinico Humanitas, Rozzano (M.E., G.R.), Italy.

^* To whom correspondence should be addressed. E-mail: gaitaf{at}libero.it.

Background--The aim of this study was to clarify the role of pulmonary vein isolation (PVI) alone versus left atrial linear lesions in the treatment of permanent atrial fibrillation (AF) in patients with left atrial dilatation and valvular disease. The primary end point was to assess the persistence of sinus rhythm (SR) off antiarrhythmic drugs (AADs) at 2-year follow-up and to correlate clinical outcome with surgical results validated with electroanatomic mapping (EAM).

Methods and Results--A total of 105 patients with permanent AF undergoing valve surgery were assigned to 3 different groups: in groups "U" and "7," left atrial linear cryoablation was performed, whereas in group "PV" patients, anatomic cryoisolation of pulmonary veins only was performed. In groups U and 7, SR was achieved in 57% of patients, whereas it was achieved in 20% of PV patients during 2-year follow-up. In the first 51 patients, the ablation schemes were validated with EAM. The EAM showed that the U lesion was never obtained: in 59% of these patients, a complete 7 lesion was achieved instead; in the 7 group, a complete 7 lesion was present in 65% of patients, whereas a complete PVI was obtained in 71% of patients. Considering patients in whom a complete 7 lesion was demonstrated with the EAM, SR without AADs was achieved in 86% of patients, whereas only 25% of patients with complete PVI were in SR without AADs.

Conclusions--In patients with permanent AF, left atrial dilatation and valvular heart disease linear lesions in the posterior region of the left atrium are more effective than PVI alone. With cryoablation, the surgical intent is fulfilled in only approximately 65% of the cases. Knowing the real anatomic and electrophysiological effects of surgical ablation is necessary to correctly interpret the clinical outcome.

Key words: cryoablation • fibrillation • heart disease

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