Vnitr Lek 2007, 53(3):231-241

Catheter ablation of chronic atrial fibrillation using circumferential and complex linear lesions in the left atrium: modes of arrhythmia termination and long-term clinical outcome

M. Fiala*, J. Chovančík, R. Neuwirth, R. Nevřalová, O. Jiravský, H. Szymeczek, D. Wojnarová, R. Moravec, L. Škňouřil, M. Dorda, J. Januška, I. Nykl, J. Černý, M. Branny
Oddělení kardiologie, Nemocnice Podlesí a.s., Třinec, přednosta prim. MUDr. Marian Branny

Objective:
The aim of the article is to present the method and results of catheter ablation for chronic atrial fibrillation.

Method:
Catheter ablation for chronic atrial fibrillation was performed in 82 patients (18 females, aged 54 ± 10 years), in 112 ablation procedures. Mean duration of the chronic phase of atrial fibrillation was 28 ± 28 months. Before ablation, amiodarone was administered without effect to 74 (90 %) patients, and was counter-indicated in 8 (10 %) patients. Ablation strategy consisted of circumferential lesions around the pulmonary veins and of complex linear lesions in the left atrium. Full pulmonary vein antra isolation, and sinus rhythm restoration, or at least converting atrial fibrillation into the left atrial tachycardia, were the procedure end points.

Results:
Sinus rhythm was restored by ablation at least in one of the ablation procedures in 43 (52 %) patients. During the follow-up period spanning 17.3 ± 11.6 months after the last ablation, stable sinus rhythm was achieved in 63 (77 %) patients, of whom 38 (60 %) had their sinus rhythm restored by ablation and another 14 (22 %) their atrial fibrillation converted into the left atrial tachycardia. Of the 63 patients with stable sinus rhythm, class I or III antiarrhythmic medication has been maintained in 21 (33 %) patients, and amiodarone has been taken by 13 (21 %) patients.

Conclusion:
Catheter ablation of chronic atrial fibrillation is potentially highly effective in long-term restoration of sinus rhythm.

Keywords: atrial fibrillation; chronic atrial fibrillation; catheter ablation; left atrium

Received: September 8, 2006; Accepted: December 18, 2006; Published: March 1, 2007  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Fiala M, Chovančík J, Neuwirth R, Nevřalová R, Jiravský O, Szymeczek H, et al.. Catheter ablation of chronic atrial fibrillation using circumferential and complex linear lesions in the left atrium: modes of arrhythmia termination and long-term clinical outcome. Vnitr Lek. 2007;53(3):231-241.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Allessie MA, Lammers WJEP, Bonke M et al. Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. In: Zipes DP, Jalife J (eds.): Cardiac Arrhythmias. New York: Grune & Stratton, Inc, 1985, 265-275.
    2. Calò L, Lamberti F, Loricchio L et al. Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study. J Am Coll Cardiol 2006; 47: 2504-2512. Go to original source... Go to PubMed...
    3. Earley MJ, Abrams DJR, Staniforth AD et al. Ceatheter ablation of permanent atrial fibrillation: medium term results. Heart 2006; 92: 233-238. Go to original source... Go to PubMed...
    4. Fiala M, Chovančík J, Heinc P et al. Léčba symptomatické intermitentní fibrilace síní katetrovou ablací v levé srdeční síni: bezprostřední a dlouhodobé výsledky u 150 pacientů. Vnitř Lék 2005; 51: 971-983.
    5. Fuster V, Rydén LE, Asinger RW et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. Circulation 2001; 104: 2118-2150. Go to original source... Go to PubMed...
    6. Fuster V, Rydén LE, Cannom DS et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. Circulation 2006; 114; 700-752. Go to original source...
    7. Haïssaguerre M, Hocini M, Sanders P et al. Catheter ablation of long-lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol 2005; 16: 1138-1147. Go to original source... Go to PubMed...
    8. Haïssaguerre M, Sanders P, Hocini M et al. Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination. J Cardiovasc Electrophysiol 2005; 16: 1125-1137. Go to original source... Go to PubMed...
    9. Haïssaguerre M, Shah DC, Jais P et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000; 101: 1409-1417. Go to original source... Go to PubMed...
    10. Harada A, Konishi T, Fukata M et al. Intraoperative map guided operation for atrial fibrillation due to mitral valve disease. Ann Thorac Surg 2000; 69: 446-451. Go to original source... Go to PubMed...
    11. Harada A, Sasaki K, Fukushima T et al. Atrial activation during chronic atrial fibrillation in patients with isolated mitral valve disease. Ann Thorac Surg 1996; 61: 104-112. Go to original source... Go to PubMed...
    12. Ho Y, Sanchez-Quintana D, Cabrera JA et al. Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1999; 10: 1525-1533. Go to original source...
    13. Jaïs P, Haïsssaguerre M, Shah DC et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 1997; 95: 572-576. Go to original source... Go to PubMed...
    14. Jalife J, Berenfeld O, Mansour M Mother rotors and fibrillatory conduction: A mechanisms of atrial fibrillation. Cardiovasc Res 2000; 54: 204-216. Go to original source... Go to PubMed...
    15. Kumagai K, Yasuda T, Tojo H et al. Role of rapid focal activation in the maintenance of atrial fibrillation originating from the pulmonary veins. Pacing Clin Electrophysiol 2000; 11: 1823-1827. Go to original source... Go to PubMed...
    16. Mandapati R, Skanes A, Chen J et al. Stable microreentrant sources as a mechanism of atrial fibrillation in the isolated sheep heart. Circulation 2000; 101: 104-199. Go to original source... Go to PubMed...
    17. Marrouche NF, Dresing T, Cole C et al. Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation. J Am Coll Cardiol 2002; 40: 464-474. Go to original source... Go to PubMed...
    18. Moe GK, Abildskov JA et al. Atrial fibrillation as a self sustaining arrhythmia independent of focal discharge. Am Heart J 1959; 58: 59-70. Go to original source... Go to PubMed...
    19. Morillo CA, Klein GJ, Jones SL et al. Chronic rapid atrial pacing: structural, functional and electrophysiological characteristics of a new model of sustained atrial fibrillation. Circulation 1995; 91: 1588-1595. Go to original source... Go to PubMed...
    20. Nademanee K, McKenzie J, Kosar E et al. A new approach for catheter ablation of atrial fibrillation: mapping and the electrophysiologic substrate. J Am Coll Cardiol 2004; 43: 2044-2053. Go to original source... Go to PubMed...
    21. Oral H, Chung A, Good E et al. A tailored approach to catheter ablation of paroxysmal atrial fibrillation. Circulation 2006; 113: 1824-1831. Go to original source... Go to PubMed...
    22. Oral H, Ozaydin M, Tada H et al. Mechanistic significance of intermittent pulmonary vein tachycardia in patients with atrial fibrillation. J Cardiovascular Electrophysiol 2002; 13: 645-650. Go to original source... Go to PubMed...
    23. Oral H, Pappone C, Chung A et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med 2006; 354: 934-941. Go to original source... Go to PubMed...
    24. Oral H, Scharf C, Chugh A et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003; 108: 2355-2360. Go to original source... Go to PubMed...
    25. Ouyang F, Bänsch D, Ernst S et al. Complete isolation of the left atrium surrounding the pulmonary veins: new insights form the double-lasso technique in paroxysmal atrial fibrillation. Circulation 2004; 110: 2090-2096. Go to original source... Go to PubMed...
    26. Pappone C, Oreto G, Rosanio S et al. Atrial electroanatomic remodelling after circumferential radiofrequency pulmonary vein ablation. Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104: 2539-2544. Go to original source... Go to PubMed...
    27. Pappone C, Santinelli V, Manguso F et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation 2004; 109: 327-334. Go to original source... Go to PubMed...
    28. Sahadevan J, Kyungmoo R, Peltz L et al. Epicardial mapping of chronic atrial fibrillation in patients: preliminary observations. Circulation 2004; 110: 3293-3299. Go to original source... Go to PubMed...
    29. Scherlag BJ, Yamanashi W, Patel U et al. Autonomically induced conversion of pulmonary vein focal firing into atrial fibrillation. J Am Coll Cardiol 2005; 45: 1878-1886. Go to original source... Go to PubMed...
    30. Sueda T, Nagata H, Shikata H et al. Simple left atrial procedure for chronic atrial fibrillation associated with mitral valve disease. Ann Thorac Surg 1996; 62: 1796-1800. Go to original source... Go to PubMed...

    Return to the content


    Vnitřní lékařství

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.