Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions

Kottkamp, Hans; Tanner, Hildegard; Kobza, Richard; Schirdewahn, Petra; Dorszewski, Anja; Gerds‐Li, Jin‐Hong; Carbucicchio, Corrado; Piorkowski, Christopher; Hindricks, Gerhard

doi:10.1016/j.jacc.2004.04.049

Cited by 95 publications

(26 citation statements)

References 17 publications

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“…Among the 53 asymptomatic patients, an episode of AF was captured in one patient (2%) during the study period. The lower incidence of asymptomatic AF recurrence, as compared with our series, might reflect the shorter period of follow-up evaluated (one versus three months) and the choice of Oral et al (13) of scanning 30 days of the long-term follow-up rather than 90 days of the short-term follow-up, in which the incidence of AF recurrence is higher (14,15). Clinical implications for anticoagulation.…”

Section: Abbreviations and Acronymsmentioning

confidence: 52%

Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation

Senatore

Stabile

Bertaglia

et al. 2005

Journal of the American College of Cardiology

154

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Section: Abbreviations and Acronymsmentioning

confidence: 52%

Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation

Senatore

Stabile

Bertaglia

et al. 2005

Journal of the American College of Cardiology

154

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“…The strength of these observations is strictly hypothesis generating, as the incidence of postablation AF has been shown to increase with an increased frequency and longer duration of post-ablation ambulatory monitoring. 20,21 Despite the limitations of a lack of long-term monitoring to define each patient’s AF burden and a defined antiarrhythmic drug regimen post-LAA ligation, the finding that LAA ligation is correlated with a reduced incidence of AF at 1 year and in the patients with a pacemaker is intriguing and is deserving of further study in a large cohort with systematic monitoring follow-up and multivariable analysis. This concept is supported by data from patients who underwent catheter ablation for the isolation of the LAA during ablation for recurrent AF, and the finding that LAA electrical isolation is associated with an increased probability of maintaining sinus rhythm.…”

Section: Discussionmentioning

confidence: 99%

The effects of LAA ligation on LAA electrical activity

Han¹,

Bartuś²,

Lakkireddy³

et al. 2014

Heart Rhythm

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BACKGROUND The arrhythmic role of the left atrial appendage (LAA) has been implicated in the maintenance of persistent atrial fibrillation. LAA isolation with catheter ablation has been successful but is limited by the risk of tamponade and electromechanical dissociation with the potential for LAA thrombus formation. OBJECTIVE To assess whether LAA ligation results in LAA electrical isolation. METHODS A total of 68 patients with contraindication or intolerance to oral anticoagulation therapy underwent LAA ligation with the LARIAT suture delivery device. Patients had unipolar [n = 30 (44%)] or bipolar [n = 38(56%)] voltage measurements pre- and post-LAA ligation. RESULTS All 68 patients underwent successful LAA ligation. There was a statistically significant reduction in the mean LAA voltage from pre-ligation (unipolar pre-ligation voltage 1.1 ± 0.53 mV; bipolar pre-ligation voltage 4.7 ± 2.83 mV) to post-ligation (unipolar post-ligation voltage 0.3 ± 0.38 mV; bipolar post-ligation voltage 0.6 ± 0.27 mV). Ninety-four percent of the patients had a reduction in the LAA voltage after the closure of the snare, with 10 of 30 (33%) of the patients having complete elimination of LAA voltage with the initial tightening of the suture. Pacing from the LAA after the closure of the snare resulted in lack of capture of the left atrium in 28 of 31 patients. CONCLUSIONS The snare closure of the LAA using the LARIAT device produces an acute reduction in the LAA voltage and inhibits the capture of the left atrium during LAA pacing. Future studies are needed to determine whether LAA ligation affects atrial fibrillation burden.

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“…[17][18][19] In contrast, some studies showed that the outcome of patients was independent of whether the PVs were isolated and also independent of the number of isolated PVs. 4,6,20,21 Thus, until now there has been a lack of conclusive scientific evidence of whether complete isolation of the PVs is necessary for successful ablation of AF ablation. The Gap-AFGerman AF Competence Network (AFNET) 1 trial was initiated by and performed within the AFNET to test the hypothesis that complete electric isolation of PVs as recorded by a circular catheter within the PVs is superior to incomplete electric isolation.…”

Section: Kuck Et Al Ablation Strategies For Atrial Fibrillationmentioning

confidence: 99%

Impact of Complete Versus Incomplete Circumferential Lines Around the Pulmonary Veins During Catheter Ablation of Paroxysmal Atrial Fibrillation

Kück

Hoffmann

Ernst

et al. 2016

Circ: Arrhythmia and Electrophysiology

226

149

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Background— Ablation of atrial fibrillation (AF) is an established treatment option for symptomatic patients. It is not known whether complete pulmonary vein isolation (PVI) is superior to incomplete PVI with regard to the patients’ clinical outcome. Methods and Results— Patients with drug-refractory, symptomatic paroxysmal AF were randomly assigned to either incomplete (group A) or complete PVI (group B). In group A, a persistent gap was intentionally left within the circumferential ablation line, whereas in group B, complete PVI without any gaps was intended. At 3 months, all patients underwent invasive reevaluation to assess the rate of persistent PVI. Clinical follow-up was based on daily 30-s transtelephonic ECG transmissions. Primary study end point was the time to first recurrence of (symptomatic or asymptomatic) AF. A total of 233 patients were enrolled (116 in group A and 117 in group B). AF recurrence within 3 months was observed in a total of 161 patients (136 [84.5%] with symptomatic and 25 [15.5%] with asymptomatic AF); AF recurred in 62.2% of group B patients and 79.2% of group A patients ( P <0.001), for a difference in favor of complete PVI of 17.1% (95% confidence interval, 5.3%–28.9%). Invasive restudy in 103 group A patients and 93 group B patients revealed conduction gaps in 92 (89.3%) and 65 (69.9%) patients, respectively. Conclusions— This study proves the superiority of complete PVI over incomplete PVI with respect to AF recurrence within 3 months. However, the rate of electric reconduction 3 months after PVI is high in patients with initially isolated PVs. Clinical Trial Registration— URL: http://clinicaltrials.gov ; Unique identifier: NCT00293943.

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Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions

Abstract: The results obtained in patients with AF treated with circular plus linear left atrial lesions strongly indicate that substrate modification is the main underlying pathophysiologic mechanism and that it results in a delayed cure instead of an immediate cure.

Cited by 95 publications

References 17 publications

Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation

Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation

The effects of LAA ligation on LAA electrical activity

Impact of Complete Versus Incomplete Circumferential Lines Around the Pulmonary Veins During Catheter Ablation of Paroxysmal Atrial Fibrillation

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