Document Detail


Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome.
MedLine Citation:
PMID:  15184286     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The modification of atrial fibrillation cycle length (AFCL) during catheter ablation in humans has not been evaluated. METHODS AND RESULTS: Seventy patients undergoing ablation of prolonged episodes of AF were randomized to pulmonary vein (PV) isolation or additional ablation of the mitral isthmus. Mean AFCL was determined at a distance from the ablated area (coronary sinus) at the following intervals: before ablation, after 2- and 4-PV isolations, and after linear ablation. Inducibility of sustained AF (> or =10 minutes) was determined before and after ablation. Spontaneous sustained AF (715+/-845 minutes) was present in 30 patients and induced in 26 (AFCL, 186+/-19 ms). PV isolation terminated AF in 75%, with the number of PVs requiring isolation before termination increasing with AF duration (P=0.018). PV isolation resulted in progressive or abrupt AFCL prolongation to various extents, depending on the PV: to 214+/-24 ms (P<0.0001) when AF terminated and to 194+/-19 ms (P=0.002) when AF persisted. The increase in AFCL (30+/-17 versus 14+/-11 ms; P=0.005) and the decrease in fragmentation (30.0+/-26.8% to 10.3+/-14.5%; P<0.0001) were significantly greater in patients with AF termination. Linear ablation prolonged AFCL, with a greater prolongation in patients with AF termination (44+/-13 versus 22+/-23 ms; P=0.08). Sustained AF was noninducible in 57% after PV isolation and in 77% after linear ablation. At 7+/-3 months, 74% with PV isolation and 83% with linear ablation were arrhythmia free without antiarrhythmics, which was significantly associated with noninducibility (P=0.03) with a recurrence rate of 38% and 13% in patients with and without inducibility, respectively. CONCLUSIONS: AF ablation results in a decline in AF frequency, with a magnitude correlating with termination of AF and prevention of inducibility that is predictive of subsequent clinical outcome.
Authors:
Michel Haïssaguerre; Prashanthan Sanders; Mélèze Hocini; Li-Fern Hsu; Dipen C Shah; Christophe Scavée; Yoshihide Takahashi; Martin Rotter; Jean-Luc Pasquié; Stéphane Garrigue; Jacques Clémenty; Pierre Jaïs
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2004-06-07
Journal Detail:
Title:  Circulation     Volume:  109     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-22     Completed Date:  2004-12-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3007-13     Citation Subset:  AIM; IM    
Affiliation:
Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux, France. jacques.clementy@pu.u-bordeaux2.fr
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / physiopathology,  surgery*
Atrial Flutter / etiology,  physiopathology
Catheter Ablation*
Disease-Free Survival
Electrocardiography
Female
Follow-Up Studies
Heart Conduction System / physiopathology*
Humans
Male
Middle Aged
Mitral Valve / physiopathology,  surgery*
Pulmonary Veins / physiopathology,  surgery*
Treatment Outcome
Tricuspid Valve / physiopathology,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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