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.
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.
Authors: Andrew Robertson Gavin; Cameron B Singleton; John Bowyer; Andrew D McGavigan Journal: J Interv Card Electrophysiol Date: 2011-09-21 Impact factor: 1.900
Authors: Troy J Badger; Marcos Daccarett; Nazem W Akoum; Yaw A Adjei-Poku; Nathan S Burgon; Thomas S Haslam; Saul Kalvaitis; Suman Kuppahally; Gaston Vergara; Lori McMullen; Paul A Anderson; Eugene Kholmovski; Rob S MacLeod; Nassir F Marrouche Journal: Circ Arrhythm Electrophysiol Date: 2010-03-24
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