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Catheter ablation of long-standing persistent atrial fibrillation: a lesson from circumferential pulmonary vein isolation.
MedLine Citation:
PMID:  20487116     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
INTRODUCTION: Circumferential pulmonary vein isolation (CPVI) is associated with a high success rate in patients with paroxysmal and persistent atrial fibrillation (AF). However, in patients with long-standing persistent AF, the ideal ablation strategy still remains a matter of debate.
METHODS AND RESULTS: Two-hundred and five patients underwent catheter ablation for long-standing persistent AF defined as continuous AF of more than 1-year duration. In a first step, all patients underwent CPVI. If direct-current cardioversion failed following CPVI, ablation of complex fractionated atrial electrograms (CFAEs) was performed. The goal was conversion into sinus rhythm (SR) or, alternatively, atrial tachycardia (AT) with subsequent ablation. A total of 340 procedures were performed. CPVI alone was performed during 165 procedures in 124 of 205 (60.5%) patients. In the remaining 81 patients, additional CFAE ablation was performed in 45, left linear lesions for recurrent ATs in 44 and SVC isolation in 15 patients, respectively, resulting in inadvertent left atrial appendage isolation in 9 (4.4%) patients. After the initial ablation procedure, 67 of 199 patients remained in SR during a mean follow-up of 19 ± 11 months. Six patients were lost to follow-up. After a mean of 1.7 ± 0.8 procedures, 135 of 199 patients (67.8%) remained in SR. Eighty-six patients (43.2%) remained in SR following CPVI performed as the sole ablative strategy.
CONCLUSIONS: CPVI alone is sufficient to restore SR in 43.2% of patients with long-standing persistent AF. Multiple procedures and additional ablation strategies with a significant risk of inadvertent left atrial appendage isolation are often required to maintain stable SR.
Authors:
Roland Richard Tilz; K R Julian Chun; Boris Schmidt; Alexander Fuernkranz; Erik Wissner; Ilka Koester; Dietmar Baensch; Sigrid Boczor; Buelent Koektuerk; Andreas Metzner; Thomas Zerm; Sabine Ernst; Matthias Antz; Karl-Heinz Kuck; Feifan Ouyang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-11-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1085-93     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Affiliation:
II. Medizinische Abteilung, Asklepios Klinik St. Georg, Hamburg, Germany.
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