Circulation. 2003;108:2355-2360
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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(Circulation. 2003;108:2355.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Catheter Ablation for Paroxysmal Atrial Fibrillation
Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation
From the Division of Cardiology, University of Michigan, Ann Arbor.
Correspondence to Hakan Oral, MD, Cardiology, TC B1 140D, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0311. E-mail oralh{at}umich.edu
Received June 23, 2003; revision received August 11, 2003; accepted August 13, 2003.
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.
Key Words: fibrillation • catheter ablation • veins • lung • atrium
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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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H. Tanner, G. Hindricks, R. Kobza, A. Dorszewski, P. Schirdewahn, C. Piorkowski, J.-H. Gerds-Li, and H. Kottkamp Trigger Activity More Than Three Years After Left Atrial Linear Ablation Without Pulmonary Vein Isolation in Patients With Atrial Fibrillation J. Am. Coll. Cardiol., July 19, 2005; 46(2): 338 - 343. [Abstract] [Full Text] [PDF]
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G. Hindricks, C. Piorkowski, H. Tanner, R. Kobza, J.-H. Gerds-Li, C. Carbucicchio, and H. Kottkamp Perception of Atrial Fibrillation Before and After Radiofrequency Catheter Ablation: Relevance of Asymptomatic Arrhythmia Recurrence Circulation, July 19, 2005; 112(3): 307 - 313. [Abstract] [Full Text] [PDF]
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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]
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T. Arentz, R. Weber, N. Jander, G. Burkle, J. von Rosenthal, T. Blum, J. Stockinger, L. Haegeli, F. J. Neumann, and D. Kalusche Pulmonary haemodynamics at rest and during exercise in patients with significant pulmonary vein stenosis after radiofrequency catheter ablation for drug resistant atrial fibrillation Eur. Heart J., July 2, 2005; 26(14): 1410 - 1414. [Abstract] [Full Text] [PDF]
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P. Zimetbaum An Argument for Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation Circulation, June 14, 2005; 111(23): 3150 - 3156. [Full Text] [PDF]
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D. J. Callans Comparing Different Strategies for Catheter Ablation of Atrial Fibrillation Circulation, June 7, 2005; 111(22): 2866 - 2868. [Full Text] [PDF]
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M. R. Karch, B. Zrenner, I. Deisenhofer, J. Schreieck, G. Ndrepepa, J. Dong, K. Lamprecht, P. Barthel, E. Luciani, A. Schomig, et al. Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation: A Randomized Comparison Between 2 Current Ablation Strategies Circulation, June 7, 2005; 111(22): 2875 - 2880. [Abstract] [Full Text] [PDF]
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A. M. Gillinov, P. M. McCarthy, E. H. Blackstone, J. Rajeswaran, G. Pettersson, J. F. Sabik III, L. G. Svensson, D. M. Cosgrove, K. M. Hill, G. V. Gonzalez-Stawinski, et al. Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1322 - 1329. [Abstract] [Full Text] [PDF]
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M. Hocini, P. Sanders, P. Jais, L.-F. Hsu, R. Weerasoriya, C. Scavee, Y. Takahashi, M. Rotter, F. Raybaud, L. Macle, et al. Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins Eur. Heart J., April 1, 2005; 26(7): 696 - 704. [Abstract] [Full Text] [PDF]
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F. H.M. Wittkampf, M. F. van Oosterhout, P. Loh, R. Derksen, E.-j. Vonken, P. J. Slootweg, and S. Y. Ho Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis Eur. Heart J., April 1, 2005; 26(7): 689 - 695. [Abstract] [Full Text] [PDF]
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R. Cappato Towards more effective techniques for catheter ablation of atrial fibrillation: to aim for electrical disconnection of pulmonary veins or not? Eur. Heart J., April 1, 2005; 26(7): 627 - 630. [Full Text] [PDF]
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T. D. Bahnson Clinician's Commentary Radiology, April 1, 2005; 235(1): 49 - 50. [Full Text] [PDF]
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R. Cappato, H. Calkins, S.-A. Chen, W. Davies, Y. Iesaka, J. Kalman, Y.-H. Kim, G. Klein, D. Packer, and A. Skanes Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation Circulation, March 8, 2005; 111(9): 1100 - 1105. [Abstract] [Full Text] [PDF]
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T.-J. Cha, J. R. Ehrlich, L. Zhang, D. Chartier, T. K. Leung, and S. Nattel Atrial Tachycardia Remodeling of Pulmonary Vein Cardiomyocytes: Comparison With Left Atrium and Potential Relation to Arrhythmogenesis Circulation, February 15, 2005; 111(6): 728 - 735. [Abstract] [Full Text] [PDF]
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