Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome

Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Fréderic Sacher, Li Fern Hsu, Yoshihide Takahashi, Martin Rotter, Thomas Rostock, Chrishan J. Nalliah, Jacques Clémenty, Michel Haïssaguerre

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Abstract

Aims: To evaluate the contribution of the posterior left atrium (LA) to chronic atrial fibrillation (AF). Methods and results: Twenty-seven patients with chronic-AF were studied. After pulmonary vein (PV) isolation, the posterior-LA was isolated by ablation joining the right- and left-PVs using an irrigated-tip catheter. Isolation was demonstrated by absent/dissociated posterior-LA activity and the inability to pace the region. Ablation impact was determined by the effect on cycle length (CL) and AF termination. Posterior-LA isolation was achieved using 35 ± 12 min of radiofrequency with total fluoroscopic and procedural durations of 64 ± 16 and 199 ± 46 min, resulting in abolition of electrograms (n = 21) or autonomous activity (n = 6; CL 820 ± 343 ms). AFCL increased from 156 ± 28 ms to 162 ± 27 ms with PV-isolation and to 175 ± 32 ms by posterior-LA exclusion (P < 0.0001). AF persisted in all after PV-isolation and terminated in 5 (19%) during posterior-LA-isolation. After 10 ± 6 months, 12 patients developed atrial tachycardia (four) or AF (eight); four underwent repeat posterior-LA-isolation, while the others required additional ablation/antiarrhythmics. After 21 ± 5 months, 17 (63%) were in sinus rhythm following posterior-LA-isolation. Conclusion: This study demonstrates the feasibility of complete posterior-LA exclusion by catheter ablation. This strategy results in maintenance of sinus rhythm in 63% at ∼2 years follow-up.

Original languageEnglish
Pages (from-to)1862-1871
Number of pages10
JournalEuropean heart journal
Volume28
Issue number15
DOIs
Publication statusPublished - 1 Aug 2007

Keywords

  • Ablation
  • Arrhythmia
  • Atrial fibrillation
  • Electrophysiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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