Circulation. 2004;110:3036-3042
Published online before print November 1, 2004, doi: 10.1161/01.CIR.0000147186.83715.95
Published online before print November 1, 2004, doi: 10.1161/01.CIR.0000147186.83715.95
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(Circulation. 2004;110:3036-3042.)
© 2004 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Prevention of Iatrogenic Atrial Tachycardia After Ablation of Atrial Fibrillation
A Prospective Randomized Study Comparing Circumferential Pulmonary Vein Ablation With a Modified Approach
From the Department of Cardiology, Electrophysiology and Cardiac Pacing Unit, San Raffaele University Hospital, Milan, Italy.
Correspondence to Carlo Pappone, MD, or Vincenzo Santinelli, MD, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail carlo.pappone{at}hsr.it or vincenzo.santinelli@hsr.it
Received May 10, 2004; revision received August 5, 2004; accepted August 18, 2004.
Background— Circumferential pulmonary vein ablation (CPVA) is effective in curing atrial fibrillation (AF), but new-onset left atrial tachycardia (AT) is a potential complication. We evaluated whether a modified CPVA approach including additional ablation lines on posterior wall and the mitral isthmus would reduce the incidence of AT after PV ablation.
Methods and Results— A total of 560 patients (291 men, 52%; age, 56.5±7.3 years) entered the study; 280 were randomized to CPVA alone (group 1) and 280 to modified CPVA (group 2). The primary end point was freedom from AT after the procedure. In group 1, 28 patients (10%) experienced new-onset AT, and 41 (14.3%) experienced recurrent AF. In group 2, 11 patients (3.9%) experienced AT, and 36 (12.9%) had recurrent AF. Group 1 was more likely to experience AT than group 2 (P=0.005). Freedom from AF after ablation was similar in both groups (P=0.57). Among those in group 1, gap-related macroreentrant AT was documented in 23 of the 28 patients (82%), and focal AT was found in 5 (18%). In group 2, gap-related macroreentrant AT was found in 8 of the 11 patients (73%), and focal AT was seen in 3 (27%). Two patients in group 1 and 1 patient in group 2 had both AT and AF. The strongest predictor of AT was the presence of gaps (P<0.001).
Conclusions— Modified CPVA is as effective as CPVA in preventing AF but is associated with a lower risk of developing incessant AT.
Key Words: ablation • fibrillation, atrial • mapping • tachycardia, ectopic atrial
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|
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|
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|
|
|
|
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|
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|
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|
|
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|
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|
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|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
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|
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|
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|
|
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|
|
|
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|
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|
|
|
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|
|
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|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
C. Pappone, G. Vicedomini, F. Manguso, F. Gugliotta, P. Mazzone, S. Gulletta, N. Sora, S. Sala, A. Marzi, G. Augello, et al. Robotic Magnetic Navigation for Atrial Fibrillation Ablation J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1390 - 1400. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Oral, C. Pappone, A. Chugh, E. Good, F. Bogun, F. Pelosi Jr., E. R. Bates, M. H. Lehmann, G. Vicedomini, G. Augello, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N. Engl. J. Med., March 2, 2006; 354(9): 934 - 941. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M J Earley, D J R Abrams, A D Staniforth, S C Sporton, and R J Schilling Catheter ablation of permanent atrial fibrillation: medium term results Heart, February 1, 2006; 92(2): 233 - 238. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
F. Ouyang, S. Ernst, J. Chun, D. Bansch, Y. Li, A. Schaumann, H. Mavrakis, X. Liu, F. T. Deger, B. Schmidt, et al. Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique Circulation, November 15, 2005; 112(20): 3038 - 3048. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
C. Pappone and V. Santinelli Reply J. Am. Coll. Cardiol., August 16, 2005; 46(4): 739 - 740. [Full Text] [PDF]
|
|
|
|
|
|
R. Cappato Towards a unified strategy for atrial fibrillation ablation?: reply Eur. Heart J., August 2, 2005; 26(16): 1688 - 1688. [Full Text] [PDF]
|
|
|
|
|
|
C. Pappone and V. Santinelli Towards a unified strategy for atrial fibrillation ablation? Eur. Heart J., August 2, 2005; 26(16): 1687 - 1688. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
D. J. Callans Comparing Different Strategies for Catheter Ablation of Atrial Fibrillation Circulation, June 7, 2005; 111(22): 2866 - 2868. [Full Text] [PDF]
|
|
|
|
|
|
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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