BACKGROUND: Each of the two main approaches to catheter ablation of atrial fibrillation (AF, segmental and circumferential) is associated with moderate long-term efficacy. OBJECTIVE: To report the long-term outcomes of a modified technique that combines circumferential ablation with pulmonary vein (PV) isolation, determined by a circular mapping catheter and to determine the relationship between complete PV isolation and long-term efficacy. METHODS: The patient population was composed of 64 consecutive patients (47 men [73%]; age 59 +/- 11 years) with AF who underwent catheter ablation. AF was paroxysmal in 29 (45%) and nonparoxysmal in 35 (55%). Each patient was followed for a minimum of 12 months. RESULTS: After a mean follow-up of 13 +/- 1 months, the long-term single-procedure success rate was 45% (n = 29) with an additional 4% (n = 3) of patients demonstrating improvement. With repeat procedures in 19 patients, the overall long-term success rate was 62% (n = 40) with 9% (n = 6) demonstrating improvement. All the patients who underwent repeat ablations had recovered PV conduction. Incomplete PV isolation was the only independent predictor of failure. A major complication occurred in four (6%) patients, including three patients with vascular complications and one with cardiac tamponade. CONCLUSION: Our results suggest that the long-term single-procedure efficacy of circumferential ablation with PV isolation in a cohort of patients with predominantly nonparoxysmal AF approaches 50%. Repeat procedures involving re-isolation of the PVs result in a significant improvement in outcomes. Complete electrical isolation of the PVs has a significant impact on the long-term efficacy of the procedure.
BACKGROUND: Each of the two main approaches to catheter ablation of atrial fibrillation (AF, segmental and circumferential) is associated with moderate long-term efficacy. OBJECTIVE: To report the long-term outcomes of a modified technique that combines circumferential ablation with pulmonary vein (PV) isolation, determined by a circular mapping catheter and to determine the relationship between complete PV isolation and long-term efficacy. METHODS: The patient population was composed of 64 consecutive patients (47 men [73%]; age 59 +/- 11 years) with AF who underwent catheter ablation. AF was paroxysmal in 29 (45%) and nonparoxysmal in 35 (55%). Each patient was followed for a minimum of 12 months. RESULTS: After a mean follow-up of 13 +/- 1 months, the long-term single-procedure success rate was 45% (n = 29) with an additional 4% (n = 3) of patients demonstrating improvement. With repeat procedures in 19 patients, the overall long-term success rate was 62% (n = 40) with 9% (n = 6) demonstrating improvement. All the patients who underwent repeat ablations had recovered PV conduction. Incomplete PV isolation was the only independent predictor of failure. A major complication occurred in four (6%) patients, including three patients with vascular complications and one with cardiac tamponade. CONCLUSION: Our results suggest that the long-term single-procedure efficacy of circumferential ablation with PV isolation in a cohort of patients with predominantly nonparoxysmal AF approaches 50%. Repeat procedures involving re-isolation of the PVs result in a significant improvement in outcomes. Complete electrical isolation of the PVs has a significant impact on the long-term efficacy of the procedure.
Authors: Ehud J Schmidt; Maggie M Fung; Pelin Aksit Ciris; Ting Song; Ajit Shankaranarayanan; Godtfred Holmvang; Sandeep N Gupta; Miguel Chaput; Robert A Levine; Jeremy Ruskin; Vivek Y Reddy; Andre D'avila; Anthony H Aletras; Stephan B Danik Journal: Europace Date: 2013-09-06 Impact factor: 5.214
Authors: Karuna Chilukuri; Daniel Scherr; Darshan Dalal; Alan Cheng; David Spragg; Saman Nazarian; Bernadette D Barcelon; Joseph E Marine; Hugh Calkins; Charles A Henrikson Journal: J Interv Card Electrophysiol Date: 2011-05-26 Impact factor: 1.900
Authors: Ehud J Schmidt; Zion T H Tse; Tobias R Reichlin; Gregory F Michaud; Ronald D Watkins; Kim Butts-Pauly; Raymond Y Kwong; William Stevenson; Jeffrey Schweitzer; Israel Byrd; Charles L Dumoulin Journal: Magn Reson Med Date: 2014-03 Impact factor: 4.668
Authors: Gian Battista Chierchia; Lucio Capulzini; Carlo de Asmundis; Andrea Sarkozy; Antonio Sorgente; Yoshinao Yazaki; Stephan-Andreas Muller-Burri; Gaetano Paparella; Marc Lameir; Fatih Bayrak; Roberto De Ponti; Pedro Brugada Journal: Indian Pacing Electrophysiol J Date: 2010-09-05
Authors: Liza A Prudente; J Randall Moorman; Douglas Lake; Yuping Xiao; Heather Greebaum; J Michael Mangrum; John P DiMarco; John D Ferguson Journal: J Interv Card Electrophysiol Date: 2009-04-22 Impact factor: 1.900