BACKGROUND: Although mitral isthmus (MI) ablation in atrial fibrillation (AF) patients has been shown to be an effective ablative strategy, the establishment of the bidirectional conduction block of the MI is technically challenging. We investigated the usefulness of a steerable sheath for MI ablation in patients with persistent AF and its impact on the clinical outcome of persistent AF ablation. METHODS: A total of 80 consecutive patients undergoing MI ablation were randomized to 1 of the following 2 groups: group S (using a steerable long sheath) or group NS (using a nonsteerable long sheath). MI ablation was performed by using an open-irrigated ablation catheter with the guidance of a 3-dimensional mapping system. The endpoint of the MI ablation was the achievement of a bidirectional block. RESULTS:Bidirectional block through the MI was achieved in 87.5% (70/80) of patients with 14.0 ± 6.7 minutes of radiofrequency application. The bidirectional block was more frequently achieved in patients in group S compared to group NS (97.5% (39/40) vs 77.5% (31/40), P = 0.02). Additionally, epicardial ablation within the coronary sinus was less frequently required in group S compared to group NS (12.5% (5/40) vs 72.5% (29/40), P < 0.0001). Atrial tachycardia after the procedure more frequently occurred in the patients in whom MI block had not been achieved during the initial procedure (40.0% (4/10) vs 10.0% (7/70), P = 0.04). CONCLUSIONS: The MI block could be achieved in the majority of patients by using a steerable sheath. An incomplete MI block increased the risk of AT following persistent AF ablation.
RCT Entities:
BACKGROUND: Although mitral isthmus (MI) ablation in atrial fibrillation (AF) patients has been shown to be an effective ablative strategy, the establishment of the bidirectional conduction block of the MI is technically challenging. We investigated the usefulness of a steerable sheath for MI ablation in patients with persistent AF and its impact on the clinical outcome of persistent AF ablation. METHODS: A total of 80 consecutive patients undergoing MI ablation were randomized to 1 of the following 2 groups: group S (using a steerable long sheath) or group NS (using a nonsteerable long sheath). MI ablation was performed by using an open-irrigated ablation catheter with the guidance of a 3-dimensional mapping system. The endpoint of the MI ablation was the achievement of a bidirectional block. RESULTS: Bidirectional block through the MI was achieved in 87.5% (70/80) of patients with 14.0 ± 6.7 minutes of radiofrequency application. The bidirectional block was more frequently achieved in patients in group S compared to group NS (97.5% (39/40) vs 77.5% (31/40), P = 0.02). Additionally, epicardial ablation within the coronary sinus was less frequently required in group S compared to group NS (12.5% (5/40) vs 72.5% (29/40), P < 0.0001). Atrial tachycardia after the procedure more frequently occurred in the patients in whom MI block had not been achieved during the initial procedure (40.0% (4/10) vs 10.0% (7/70), P = 0.04). CONCLUSIONS: The MI block could be achieved in the majority of patients by using a steerable sheath. An incomplete MI block increased the risk of AT following persistent AF ablation.
Authors: José L Báez-Escudero; Percy Francisco Morales; Amish S Dave; Christine M Sasaridis; Young-Hoon Kim; Kaoru Okishige; Miguel Valderrábano Journal: Heart Rhythm Date: 2012-03-07 Impact factor: 6.343
Authors: Andreas Rillig; Boris Schmidt; Britta Feige; Erik Wissner; Andreas Metzner; Anita Arya; Shibu Mathew; Hisaki Makimoto; Peter Wohlmuth; Feifan Ouyang; Karl-Heinz Kuck; Roland Richard Tilz Journal: Clin Res Cardiol Date: 2013-07-30 Impact factor: 5.460
Authors: Mélèze Hocini; Ashok J Shah; Isabelle Nault; Lena Rivard; Nick Linton; Sanjiv Narayan; Shinsuke Myiazaki; Amir S Jadidi; Sébastien Knecht; Daniel Scherr; Stephen B Wilton; Laurent Roten; Patrizio Pascale; Michala Pedersen; Nicolas Derval; Frédéric Sacher; Pierre Jaïs; Jacques Clémenty; Michel Haïssaguerre Journal: J Cardiovasc Electrophysiol Date: 2012-01-09