Selective segmental ostial ablation and circumferential pulmonary veins ablation. Results of an individualized strategy to cure refractory atrial fibrillation

Tamborero, David; Mont, Lluı́s; Molina, Irma; Matiello, María; Berruezo, Antonio; Sitges, Marta; Perea, Rosario J.; Caralt, Teresa M. de; Vidal, Bárbara; Zamorano, Nibaldo; Brugada, Josep

doi:10.1007/s10840-007-9129-6

Cited by 6 publications

(3 citation statements)

References 32 publications

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“…The study cannot exclude that the LA roof linear ablation may have some effect in individual AF cases because the effect of this ablation was evaluated as part of a predefined lesion set performed in all patients. Tailored approaches for AF ablation have been proposed . Finally, arrhythmia recurrence was detected by routine 48‐hour Holter monitoring and ECG recording when symptoms occurred between scheduled visits.…”

Section: Discussionmentioning

confidence: 99%

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Benefit of Left Atrial Roof Linear Ablation in Paroxysmal Atrial Fibrillation: A Prospective, Randomized Study

Arbelo

Guiu

Ramos

et al. 2014

JAHA

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BackgroundIsolation of the pulmonary veins (PVs) for the treatment of atrial fibrillation (AF) is often supplemented with linear lesions within the left atrium (LA). However, there are conflicting data on the effects of creating a roof line (RL) joining the superior PVs in paroxysmal atrial fibrillation (PAF).Methods and ResultsA cohort of 120 patients with drug‐refractory PAF referred for ablation were prospectively randomized into 2 strategies: (1) PV isolation in combination with RL ablation (LA roof ablation [LARA]‐1: 59 patients) or (2) PV isolation (LARA‐2: 61 patients). Follow‐up was performed at 1, 3, and 6 months after the procedure and every 6 months thereafter. After a 3‐month blanking period, recurrence was defined as the ocurrence of any atrial tachyarrhythmia lasting ≥30 seconds. PV isolation was achieved in 89% and complete RL block in 81%. RF duration, fluoroscopy, and procedural times were slightly, but not significantly, longer in the LARA‐1 group. After 15±10 months, there was no difference in the arrhythmia‐free survival after a single AF ablation procedure (LARA‐1: 59% vs. LARA‐2: 56% at 12 months; log rank P=0.77). The achievement of complete RL block did not influence the results. The incidence of LA macroreentrant tachycardias was 5.1% in the LARA‐1 group (n=3) versus 8.2% in the LARA‐2 (n=5) (P=ns). Univariate analysis only identified AF duration as a covariate associated with arrhythmia recurrence (hazard ratio, 1.01 [95% confidence interval, 1.002 to 1.012]; P<0.01).ConclusionThe linear block at the LA roof is not associated with an improved clinical outcome compared with PV isolation alone.Clinical Trial RegistrationURL: ClinicalTrials.gov. Unique identifier: NCT01203241.

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Section: Discussionmentioning

confidence: 99%

“…Tailored approaches for AF ablation have been proposed. [30][31][32] Finally, arrhythmia recurrence was detected by routine 48-hour Holter monitoring and ECG recording when symptoms occurred between scheduled visits. It is likely that some arrhythmia recurrences may have escaped detection in asymptomatic patients.…”

Section: Study Limitationsmentioning

confidence: 99%

Benefit of Left Atrial Roof Linear Ablation in Paroxysmal Atrial Fibrillation: A Prospective, Randomized Study

Arbelo

Guiu

Ramos

et al. 2014

JAHA

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“…Therefore, the study cannot exclude that the isolation of the LA posterior wall may have some effect in individual AF cases. Recently, individualized approaches for AF ablation have been proposed, [37][38][39] but the criteria to preselect the ablation method in each patient or the end point for a tailored procedure are still under investigation.…”

Section: Study Limitationsmentioning

confidence: 99%

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

Tamborero

Mont

Berruezo

et al. 2009

Circ: Arrhythmia and Electrophysiology

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115

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Background-Ablation of the pulmonary veins (PVs) for atrial fibrillation treatment is often combined with linear radiofrequency lesions along the left atrium (LA) to improve the success rate. The study was designed to assess the contribution of LA posterior wall isolation to the outcome of circumferential pulmonary vein ablation (CPVA). Methods and Results-CPVA consisted of continuous radiofrequency lesions encircling both ipsilateral PVs plus an ablation line along the mitral isthmus. Patients were then randomized into 2 groups. In the first group, superior PVs were connected by linear lesions along the LA roof (CPVA-1 group). In the second group, the LA posterior wall was isolated by adding a second line connecting the inferior aspect of the 2 inferior PVs (CPVA-2 group). The study included 120 patients (53Ϯ11 years, 77% male, 60% paroxysmal atrial fibrillation, LA of 41.3Ϯ5.4 mm, 46% with hypertension, and 22% with structural heart disease). After a single ablation procedure and a mean follow-up of 10Ϯ4 months, 24 (40%) patients of the CPVA-1 group had atrial fibrillation recurrences and 3 (5%) had new-onset LA flutter. In the CPVA-2 group, recurrences were due to atrial fibrillation episodes in 23 patients (38%) and LA flutter in 4 (7%). Freedom from arrhythmia recurrences was not statistically different in the CPVA-1 group as compared with the CPVA-2 group (log rank Pϭ0.943). Conclusion-Isolation

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CCT Imaging: Cardiac Electrophysiology Applications

Shinbane¹

2008

Handbook of Cardiovascular CT

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Selective segmental ostial ablation and circumferential pulmonary veins ablation. Results of an individualized strategy to cure refractory atrial fibrillation

Cited by 6 publications

References 32 publications

Benefit of Left Atrial Roof Linear Ablation in Paroxysmal Atrial Fibrillation: A Prospective, Randomized Study

Benefit of Left Atrial Roof Linear Ablation in Paroxysmal Atrial Fibrillation: A Prospective, Randomized Study

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

CCT Imaging: Cardiac Electrophysiology Applications

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