Successful Catheter Ablation of Atrial Fibrillation

Haı̈ssaguerre, Michel; Gencel, L; Fischer, Bruno; P, Le Métayer; Poquet, F; Fi, Marcus; Clémenty, Jacques

doi:10.1111/j.1540-8167.1994.tb01146.x

Cited by 294 publications

(93 citation statements)

References 26 publications

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“…[2][3][4][5] More recently, the clinical indications for RFA have expanded to include more complex arrhythmias that require accurate placement of multiple linearly arranged lesions rather than ablation of a single focus. 6 In contrast to catheter ablation of accessory pathways and atrioventricular nodal reentrant tachycardia, for which detailed mapping is necessary to identify appropriate sites for energy delivery, sites for catheter ablation of atrial flutter and atrial fibrillation, for example, are identified almost entirely on an anatomic basis. Although the feasibility of anatomybased catheter ablation has been demonstrated with standard catheter ablation techniques, these procedures are extremely time-consuming, require prolonged fluoroscopy exposure, and have been associated with a high incidence of complications.…”

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confidence: 99%

Visualization and Temporal/Spatial Characterization of Cardiac Radiofrequency Ablation Lesions Using Magnetic Resonance Imaging

et al. 2000

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Background-The purpose of this study was to describe a system and method for creating, visualizing, and monitoring cardiac radiofrequency ablation (RFA) therapy during magnetic resonance imaging (MRI). Methods and Results-RFA was performed in the right ventricular apex of 6 healthy mongrel dogs with a custom 7F nonmagnetic ablation catheter (4-mm electrode) in a newly developed real-time interactive cardiac MRI system. Catheters were positioned to intracardiac targets by use of an MRI fluoroscopy sequence, and ablated tissue was imaged with T2-weighted fast spin-echo and contrast-enhanced T1-weighted gradient-echo sequences. Lesion size by MRI was determined and compared with measurements at gross and histopathological examination. Ablated areas of myocardium appeared as hyperintense regions directly adjacent to the catheter tip and could be detected 2 minutes after RF delivery. Lesions reached maximum size Ϸ5 minutes after ablation, whereas lesion signal intensity increased linearly with time but then reached a plateau at 12.

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confidence: 99%

Visualization and Temporal/Spatial Characterization of Cardiac Radiofrequency Ablation Lesions Using Magnetic Resonance Imaging

et al. 2000

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“…Haïssaguerre, et al reported a patient with incessant AF who was free of arrhythmias after 3 linear RF lesions were created in the right atrium. 13) Further, Haïssaguerre, et al created RA and LA linear RF lesions in patients with paroxysmal AF; the success rate was below 40% for the RA linear lesions but increased to 60% with the addition of LA lesions in patients in whom RA linear ablation initially failed. 14) Hocini, et al reported that RA ablation was required in approximately 20% of patients with persistent AF.…”

Section: Discussionmentioning

confidence: 99%

Linear Catheter Ablation of the Right Atrium for Rapid Atrial Pacing-Induced Sustained Atrial Fibrillation in Dogs

et al. 2012

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SummaryCatheter ablation of persistent/long-persistent atrial fibrillation (AF) has been shown to be less effective by pulmonary vein isolation (PVI) and additional left atrial (LA) complex fractionated atrial electrograms and long linear lesions are often required. Recent reports have demonstrated right atrial (RA) ablation increases the success rate of maintaining sinus rhythm in persistent/long-persistent AF. The aim of this study was to investigate whether effective RA linear lesions can terminate AF and render it noninducible in a canine model of rapid atrial pacing-induced sustained AF. Sustained AF was induced by rapid atrial pacing in 20 dogs. AF duration was 21-126 days (median, 50 days). Four RA linear lesions (superior vena cava-inferior vena cava, septal line, transverse line, and cavo-tricuspid line) were created with the use of 1 of 3 different ablation catheters (large-tip [8-mm tip], coil-tip, and cooled-tip catheters). AF was terminated with the large-tip catheter in 4/7 dogs (1 dog died of ventricular fibrillation [VF]), with the coil-tip catheter in 3/7 dogs (1 dog died of VF), and with the cooled-tip catheter in 1/6 dogs. In 6 dogs in which AF could not be terminated acutely by RA ablation, AF terminated spontaneously at 7-78 days (median, 14 days) after ablation. RA linear ablation terminated AF with limited success in our dog model of rapid atrial pacing-induced AF, but late AF termination was noted in the surviving dogs. Therefore, RA linear lesions in addition to the PVI and LA lesions may have additional effects on the catheter ablation for the persistent AF. (Int Heart J 2012; 53: 375-382) Key words: Radiofrequency catheter ablation, Linear lesion B ecause atrial ectopic beats originating from the pulmonary veins (PVs) have been shown to initiate paroxysmal atrial fibrillation (AF), 1) PV isolation by radiofrequency (RF) ablation guided by ring catheters is widely used for the treatment of this arrhythmia.2) The single-procedure success of catheter ablation in patients with paroxysmal AF ranges from 38% to 78%, with most centers reporting an efficacy of 60% or more.3) In contrast, the single-procedure success of catheter ablation of persistent AF ranges from 22% to 45%, with most centers reporting an efficacy of 30% or less. 3)Stepwise ablation has been shown to be effective for maintenance of sinus rhythm (SR) if AF is terminated by ablation. 4)Stepwise ablation includes PV isolation, electrogram-based ablation in the left atrium, linear ablations along the left atrial (LA) roof and mitral isthmus, and right atrial (RA) ablation and is required in approximately 20% of patients with persistent AF.5) Furthermore, linear ablation of the RA guided by the electrophysiologic characteristics of paroxysmal RA-AF is an effective approach for treating certain patients with AF.6) Ablation in the RA to create linear lesions along the intercaval posterior line and intercaval septal line and electrical disconnection of the superior vena cava (SVC) have a substantially higher rate of success than ...

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“…40 Results were largely encouraging; however, complications from these approaches, namely barotrauma and perforation, respectively, lead to the study and application of radiofrequency (RF) energy. 41 The success of RF energy application lead to its use in treating atrial flutter, 42 AF, [43][44][45] and ventricular arrhythmias. 46,47 To this day, it is the most commonly used energy source.…”

Section: Novel Ablation Modalities On the Horizonmentioning

confidence: 99%

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

Vaidya¹,

Sugure²,

Asirvatham³

2017

J Innov Cardiac Rhythm Manage

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Successful Catheter Ablation of Atrial Fibrillation

Cited by 294 publications

References 26 publications

Visualization and Temporal/Spatial Characterization of Cardiac Radiofrequency Ablation Lesions Using Magnetic Resonance Imaging

Visualization and Temporal/Spatial Characterization of Cardiac Radiofrequency Ablation Lesions Using Magnetic Resonance Imaging

Linear Catheter Ablation of the Right Atrium for Rapid Atrial Pacing-Induced Sustained Atrial Fibrillation in Dogs

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

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