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Complete antral encirclement is not required for pulmonary vein isolation.
MedLine Citation:
PMID:  20884380     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Complete circumferential antral ablation may not be necessary for successful pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF).
OBJECTIVE: We examined the feasibility of a noncircumferential approach limited to segments of the antra required for PV-atrial conduction.
METHODS: During ablation for paroxysmal AF, each PV antrum was divided into six segments, and ablation was sequentially targeted to antral segments with the earliest activity until bidirectional isolation was achieved. Ablation at the ostium was avoided. Patients requiring complete circumferential ablation (circumferential group) were compared with those undergoing incomplete antral ablation (noncircumferential group) with respect to freedom from symptomatic atrial arrhythmia, procedure, and ablation times.
RESULTS: Ninety-nine patients underwent ablation with successful isolation of PVs (n = 37 circumferential; n = 62 noncircumferential). There were no significant differences in age, gender, AF duration, or LA size. Procedure time (202 ± 45 vs. 185 ± 47 minutes; P = .06) and ablation time (51 ± 15 vs. 41 ± 14 minutes; P = .004) were shorter in the noncircumferential group. During follow-up (12 ± 6 months), freedom from symptomatic recurrence was 73% in both groups (P = .97), with organized atrial tachycardia being more common in the circumferential group (P = .06). In 22 patients undergoing repeat study, PV reconnection was demonstrated in 82% and 81% of PVs in each group. Reconnection in the noncircumferential group occurred in previously ablated segments in 10 (77%) of 13 cases.
CONCLUSIONS: Noncircumferential antral ablation achieves similar success rates with shorter procedure and ablation times than circumferential ablation. Greater attention should be focused on producing permanent lesions rather than on completing antral encirclement after isolation is achieved.
Authors:
Raymond W Sy; Lorne J Gula; Peter Leong-Sit; George J Klein; Raymond Yee; Andrew D Krahn; Cathy Bentley; Shakeeb Razak; Allan C Skanes
Publication Detail:
Type:  Journal Article     Date:  2010-09-25
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  8     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-22     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Arrhythmia Service, University of Western Ontario, London, Ontario, Canada.
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