A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation

Abstract

Background-Because the genesis of atrial fibrillation (AF) is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set. Methods and Results-Catheter ablation was performed in 153 consecutive patients (mean age, 56Ϯ11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19% of patients and was still present in 10% at Ͼ12 weeks of follow-up. A repeat ablation procedure was performed in 18% of patients. During a mean follow-up of 11Ϯ4 months, 77% of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2% of procedures. Conclusions-A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal

Catheter Ablation for Atrial Fibrillation

“…73 In patients with persistent AF who were taking amiodarone, ablation in the LA roof, septum, anterior wall, mitral isthmus, and atrial aspect of the mitral annulus restored sinus rhythm in 68% of patients not taking drugs. 46 With a stepwise approach that combined all of the aforementioned targets, termination of long-lasting persistent AF by ablation alone can be achieved in 87% of patients, 22 with freedom from AF achieved in 95% of patients.…”

Electromagnetic Mapping During Complex RF Ablations

“…This method is accepted as adjuvant to the left atrial ablation. Finally, even if the first method is use to disconnect the pulmonary veins, the procedure is escalated and elements of the second and third procedure are added (Oral H et al, 2006b;Takahashi Y et al, 2007). Although, we are still not at the end of the way in the development of atrial fibrillation ablation methods, the place of the electroanatomic mapping is well established.…”

Ablation to Treat Atrial Fibrillation: Beyond Rhythm Control

“…15 Most were younger than 65 years, were men, had normal ejection fractions, and generally did not have greatly enlarged atria. 15,16 The duration of atrial fibrillation was 3 to 7 years, and the presence of structural heart disease was variable. 15,16 Because ablation to treat atrial fibrillation is a long procedure, generally 3 to 5 hours, 7,11,12 either moderate sedation or general anesthesia is used.…”