Irrigated‐Tip Catheter Ablation of Pulmonary Veins for Treatment of Atrial Fibrillation

Macle, Laurent; Jaı̈s, Pierre; Weerasooriya, Rukshen; Hocini, Mélèze; Shah, Dipen; Choi, Kee‐Joon; Scavée, Christophe; Raybaud, Florence; Clémenty, Jacques; Haı̈ssaguerre, Michel

doi:10.1046/j.1540-8167.2002.01067.x

Cited by 133 publications

(104 citation statements)

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“…In previous studies of segmental ostial ablation to isolate the PVs, success rates of 60% to 70% were achieved in patients with PAF with the use of standard or irrigated tip catheters, and a repeat ablation was performed in 10% to 40% of patients. 2,3,6,21,22 Also consistent with the findings of the present study, 85% of patients with PAF who underwent left atrial ablation for PAF in a previous study were free from recurrent AF during a mean follow-up of 10 months. 5 Therefore, the 67% success rate in the segmental ostial ablation group and the 88% success rate in the left atrial ablation group at 6 months of follow-up in the present study are in line with the results of these previous studies.…”

Section: Previous Studiessupporting

confidence: 91%

“…However, when segmental ostial ablation was performed with a catheter capable of delivering more energy, long-term freedom from recurrent AF was similar to that reported in this study. 21 The mean duration of follow-up in this study was 164 days. Long-term follow-up will be important to determine the long-term safety and efficacy of both ablation strategies.…”

Section: Previous Studiesmentioning

confidence: 82%

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Catheter Ablation for Paroxysmal Atrial Fibrillation

et al. 2003

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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, 52Ϯ10 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 156Ϯ45 and 50Ϯ17 minutes for SOCA and 149Ϯ33 and 39Ϯ12 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 (Pϭ0.02). 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.

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Section: Previous Studiessupporting

confidence: 91%

Section: Previous Studiesmentioning

confidence: 82%

Catheter Ablation for Paroxysmal Atrial Fibrillation

et al. 2003

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“…Ablation techniques that target only the pulmonary vein ostia have had modest efficacy. 3,7,21 Consistent with the multifactorial nature of AF, 8 autonomic innervation of the left atrium, 22,23 nonpulmonary venous arrhythmogenicity, 24 multiple reentrant wavelets, 25 and anisotropic reentry leading to rotors 26,27 all have been implicated in the genesis of AF. Therefore, elimination of only the pulmonary vein input may not be sufficient in all patients with AF.…”

Section: Tailored Ablation: Mechanisms Of Actionmentioning

confidence: 89%

A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation

et al. 2006

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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

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“…9,10 the use of new devices and techniques, such as an irrigation catheter, hot balloon catheter, and cryo-ablation, may be necessary to prevent recurrence. 11,12 In segmental PV isolation, additional sessions may provide the opportunity to not only repeat ablation in segments that show recurrence, but also to find other foci that were not seen in the first session.…”

Section: Discussionmentioning

confidence: 99%