Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation

Abstract

Background-Data on the comparative value of the circumferential pulmonary vein and the segmental pulmonary vein ablation for interventional treatment of atrial fibrillation are limited. We hypothesized that the circumferential pulmonary vein ablation approach was superior to the segmental pulmonary vein ablation approach. Methods and Results-One hundred patients with highly symptomatic atrial fibrillation were randomly assigned to undergo either circumferential (nϭ50) or segmental pulmonary vein ablation (nϭ50). Freedom from atrial tachyarrhythmias in a 7-day Holter monitoring at 6 months was the primary end point. Secondary end points were freedom of arrhythmia-related symptoms and a composite of pericardial tamponade, thromboembolic complications, and pulmonary vein stenosis (safety end point). On the basis of the results of the 7-day Holter monitoring at 6 months, 21 patients (42%) after circumferential pulmonary vein ablation and 33 patients (66%) after segmental pulmonary vein ablation (Pϭ0.02) were free of atrial tachyarrhythmia episodes. During the 6-month follow-up period, 27 patients (54%) after circumferential pulmonary vein ablation and 41 patients (82%) after segmental pulmonary vein ablation remained free of arrhythmia-related symptoms (PϽ0.01). No significant difference was found in the safety end point (6 versus 7 events; Pϭ0.77) in the circumferential versus segmental pulmonary vein ablation group, respectively. Conclusions-This study demonstrates no superiority of the circumferential pulmonary vein ablation over segmental pulmonary vein ablation for treatment of atrial fibrillation in terms of efficacy and safety.

Pulmonary vein isolation and left atrial catheter ablation using a three-dimensional navigation system for the treatment of atrial fibrillation

“…The technique of performing wider linear ablations in the LA may aid in targeting different substrates that help to maintain or perpetuate AF. However, these techniques can be associated with challenges such as incidence of LA flutter (8) and complications such as atrioesophageal fistula. Furthermore, achieving complete linear block in certain anatomical regions (particularly the mitral isthmus) can be difficult (7).…”

Characterization of Left Atrial Tachyarrhythmias in Patients Following Atrial Fibrillation Ablation: Correlation of surface ECG with Intracardiac Mapping

“…[5][6][7][8][9][10] The mechanism(s) underlying development of organized atrial tachyarrhythmias in these patients as reported by various investigators remains inconsistent. One reason for this inconsistency is the use of terms atrial tachycardia (AT) and flutter interchangeably to describe these arrhythmias.…”

“…An interesting observation in this context is that centers utilizing wide area circumferential PV ablation without necessarily confirming isolation report a higher prevalence (10-24%) of macro-reentrant atypical LA flutters. 2,5,9 In contrast centers that utilize PV isolation alone have observed a low overall incidence of organized atrial tachycarrhythmias and these have predominantly been focal, originating from in and around the reconnected PV segments. 1,7,8,11 In a prospective randomized comparison of segmental PV isolation versus wide area circumferential anatomical PV ablation, Karch et al reported a significantly higher occurrence of organized atrial tacycardias in the latter group (18% versus 2%).…”

“…1,7,8,11 In a prospective randomized comparison of segmental PV isolation versus wide area circumferential anatomical PV ablation, Karch et al reported a significantly higher occurrence of organized atrial tacycardias in the latter group (18% versus 2%). 5 The likely explanation for this discrepancy is that wide area anatomical ablation results in large scars with "gap" across incomplete lesion sets.…”

Ablação por radiofreqüência da fibrilação atrial paroxística: fatores determinantes da eficácia clínica a longo-prazo

“…The literature shows varying result [7][8][9][10] , both because of differences in patient selection and because of the efficacy of these techniques 9,11,12 ; thus, there is no consensus as to which is the best therapeutic option for the control of AF patients. Also, most of these studies show results after more than one intervention and with usually short follow-up periods, thus possibly overestimating the procedural success.…”