Stepwise catheter ablation of chronic atrial fibrillation: Importance of discrete anatomic sites for termination

Pierre Jaïs, Mark D. O'Neill, Yoshihide Takahashi, Anders Jönsson, Mélèze Hocini, Frédéric Sacher, Prashanthan Sanders, Sathish Kodali, Thomas Rostock, Martin Rotter, Jacques Clémenty, Michel Haïssaguerre

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Chronic atrial fibrillation (CAF) can be acutely terminated using a combination of approaches targeting thoracic veins, left atrial areas showing rapid/heterogeneous electrical activity, and by linear ablation. This observational study emphasizes the crucial role for conventional endocardial mapping to identify discrete anatomical sites, ablation of which is indispensable for the achievement of atrial fibrillation (AF) termination. Methods: Eighty consecutive patients with CAF underwent catheter ablation using the stepwise approach. Pulmonary vein isolation and roof-line ablation were performed as the initial two steps in all patients. In the presence of locally rapid or heterogeneous activity, ablation was then performed at all sites within the left atrium and coronary sinus (CS) region with the endpoint of local organization or slowing. If AF persisted, the mitral isthmus was targeted. Patients in whom AF terminated during one of these five ablation steps were differentiated from those in whom AF was terminated by radiofrequency ablation at a single discrete anatomic site within 1 minute. Electrograms at discrete anatomic sites of termination were classified according to morphology. Results: Termination of AF was achieved in 69 (86%) patients by ablation alone. In 50 patients (72%), this occurred while following the predetermined ablation schema. In the remaining 19 patients (28%), ablation targeting a discrete site (preferentially located at the CS, the base of left atrial appendage, and the interatrial septum) terminated AF. Such sites were identified by (1) continuous electrical activity and fractionation and (2) bursts of short cycle activity (130-160 msec), centrifugal activation or local activation gradients, indicating sources perpetuating AF. Conclusion: In 28% of patients with termination of CAF, the final successful ablation site is anatomically discrete and displays electrophysiological characteristics that can be effectively identified by point and activation mapping. Failure to identify these sites may significantly reduce the likelihood of termination of CAF by catheter ablation.

LanguageEnglish
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue numberSUPPL. 3
DOIs
Publication statusPublished - 1 Dec 2006

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Electrogram

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Jaïs, Pierre ; O'Neill, Mark D. ; Takahashi, Yoshihide ; Jönsson, Anders ; Hocini, Mélèze ; Sacher, Frédéric ; Sanders, Prashanthan ; Kodali, Sathish ; Rostock, Thomas ; Rotter, Martin ; Clémenty, Jacques ; Haïssaguerre, Michel. / Stepwise catheter ablation of chronic atrial fibrillation : Importance of discrete anatomic sites for termination. In: Journal of Cardiovascular Electrophysiology. 2006 ; Vol. 17, No. SUPPL. 3.
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abstract = "Background: Chronic atrial fibrillation (CAF) can be acutely terminated using a combination of approaches targeting thoracic veins, left atrial areas showing rapid/heterogeneous electrical activity, and by linear ablation. This observational study emphasizes the crucial role for conventional endocardial mapping to identify discrete anatomical sites, ablation of which is indispensable for the achievement of atrial fibrillation (AF) termination. Methods: Eighty consecutive patients with CAF underwent catheter ablation using the stepwise approach. Pulmonary vein isolation and roof-line ablation were performed as the initial two steps in all patients. In the presence of locally rapid or heterogeneous activity, ablation was then performed at all sites within the left atrium and coronary sinus (CS) region with the endpoint of local organization or slowing. If AF persisted, the mitral isthmus was targeted. Patients in whom AF terminated during one of these five ablation steps were differentiated from those in whom AF was terminated by radiofrequency ablation at a single discrete anatomic site within 1 minute. Electrograms at discrete anatomic sites of termination were classified according to morphology. Results: Termination of AF was achieved in 69 (86{\%}) patients by ablation alone. In 50 patients (72{\%}), this occurred while following the predetermined ablation schema. In the remaining 19 patients (28{\%}), ablation targeting a discrete site (preferentially located at the CS, the base of left atrial appendage, and the interatrial septum) terminated AF. Such sites were identified by (1) continuous electrical activity and fractionation and (2) bursts of short cycle activity (130-160 msec), centrifugal activation or local activation gradients, indicating sources perpetuating AF. Conclusion: In 28{\%} of patients with termination of CAF, the final successful ablation site is anatomically discrete and displays electrophysiological characteristics that can be effectively identified by point and activation mapping. Failure to identify these sites may significantly reduce the likelihood of termination of CAF by catheter ablation.",
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Jaïs, P, O'Neill, MD, Takahashi, Y, Jönsson, A, Hocini, M, Sacher, F, Sanders, P, Kodali, S, Rostock, T, Rotter, M, Clémenty, J & Haïssaguerre, M 2006, 'Stepwise catheter ablation of chronic atrial fibrillation: Importance of discrete anatomic sites for termination', Journal of Cardiovascular Electrophysiology, vol. 17, no. SUPPL. 3. https://doi.org/10.1111/j.1540-8167.2006.00652.x

Stepwise catheter ablation of chronic atrial fibrillation : Importance of discrete anatomic sites for termination. / Jaïs, Pierre; O'Neill, Mark D.; Takahashi, Yoshihide; Jönsson, Anders; Hocini, Mélèze; Sacher, Frédéric; Sanders, Prashanthan; Kodali, Sathish; Rostock, Thomas; Rotter, Martin; Clémenty, Jacques; Haïssaguerre, Michel.

In: Journal of Cardiovascular Electrophysiology, Vol. 17, No. SUPPL. 3, 01.12.2006.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stepwise catheter ablation of chronic atrial fibrillation

T2 - Journal of Cardiovascular Electrophysiology

AU - Jaïs, Pierre

AU - O'Neill, Mark D.

AU - Takahashi, Yoshihide

AU - Jönsson, Anders

AU - Hocini, Mélèze

AU - Sacher, Frédéric

AU - Sanders, Prashanthan

AU - Kodali, Sathish

AU - Rostock, Thomas

AU - Rotter, Martin

AU - Clémenty, Jacques

AU - Haïssaguerre, Michel

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Background: Chronic atrial fibrillation (CAF) can be acutely terminated using a combination of approaches targeting thoracic veins, left atrial areas showing rapid/heterogeneous electrical activity, and by linear ablation. This observational study emphasizes the crucial role for conventional endocardial mapping to identify discrete anatomical sites, ablation of which is indispensable for the achievement of atrial fibrillation (AF) termination. Methods: Eighty consecutive patients with CAF underwent catheter ablation using the stepwise approach. Pulmonary vein isolation and roof-line ablation were performed as the initial two steps in all patients. In the presence of locally rapid or heterogeneous activity, ablation was then performed at all sites within the left atrium and coronary sinus (CS) region with the endpoint of local organization or slowing. If AF persisted, the mitral isthmus was targeted. Patients in whom AF terminated during one of these five ablation steps were differentiated from those in whom AF was terminated by radiofrequency ablation at a single discrete anatomic site within 1 minute. Electrograms at discrete anatomic sites of termination were classified according to morphology. Results: Termination of AF was achieved in 69 (86%) patients by ablation alone. In 50 patients (72%), this occurred while following the predetermined ablation schema. In the remaining 19 patients (28%), ablation targeting a discrete site (preferentially located at the CS, the base of left atrial appendage, and the interatrial septum) terminated AF. Such sites were identified by (1) continuous electrical activity and fractionation and (2) bursts of short cycle activity (130-160 msec), centrifugal activation or local activation gradients, indicating sources perpetuating AF. Conclusion: In 28% of patients with termination of CAF, the final successful ablation site is anatomically discrete and displays electrophysiological characteristics that can be effectively identified by point and activation mapping. Failure to identify these sites may significantly reduce the likelihood of termination of CAF by catheter ablation.

AB - Background: Chronic atrial fibrillation (CAF) can be acutely terminated using a combination of approaches targeting thoracic veins, left atrial areas showing rapid/heterogeneous electrical activity, and by linear ablation. This observational study emphasizes the crucial role for conventional endocardial mapping to identify discrete anatomical sites, ablation of which is indispensable for the achievement of atrial fibrillation (AF) termination. Methods: Eighty consecutive patients with CAF underwent catheter ablation using the stepwise approach. Pulmonary vein isolation and roof-line ablation were performed as the initial two steps in all patients. In the presence of locally rapid or heterogeneous activity, ablation was then performed at all sites within the left atrium and coronary sinus (CS) region with the endpoint of local organization or slowing. If AF persisted, the mitral isthmus was targeted. Patients in whom AF terminated during one of these five ablation steps were differentiated from those in whom AF was terminated by radiofrequency ablation at a single discrete anatomic site within 1 minute. Electrograms at discrete anatomic sites of termination were classified according to morphology. Results: Termination of AF was achieved in 69 (86%) patients by ablation alone. In 50 patients (72%), this occurred while following the predetermined ablation schema. In the remaining 19 patients (28%), ablation targeting a discrete site (preferentially located at the CS, the base of left atrial appendage, and the interatrial septum) terminated AF. Such sites were identified by (1) continuous electrical activity and fractionation and (2) bursts of short cycle activity (130-160 msec), centrifugal activation or local activation gradients, indicating sources perpetuating AF. Conclusion: In 28% of patients with termination of CAF, the final successful ablation site is anatomically discrete and displays electrophysiological characteristics that can be effectively identified by point and activation mapping. Failure to identify these sites may significantly reduce the likelihood of termination of CAF by catheter ablation.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Electrogram

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U2 - 10.1111/j.1540-8167.2006.00652.x

DO - 10.1111/j.1540-8167.2006.00652.x

M3 - Article

VL - 17

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - SUPPL. 3

ER -