Document Detail


Long-term evaluation of atrial fibrillation ablation guided by noninducibility.
MedLine Citation:
PMID:  16443526     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary vein (PV) isolation and linear lesions are effective in eliminating paroxysmal atrial fibrillation (AF), but linear lesions probably are not required in all patients. Noninducibility of AF has been shown to be associated with freedom from arrhythmia in 87% of patients. OBJECTIVES: The purpose of this study was to prospectively evaluate the role of noninducibility in guiding a stepwise approach tailored to the patient. METHODS: In 74 patients (age 53 +/- 8 years) with paroxysmal AF, PV isolation was performed during induced or spontaneous AF. If AF was inducible after PV isolation, one to two additional linear lesions were placed at the mitral isthmus and/or left atrial roof, with the endpoint of noninducibility of AF or atrial flutter. Inducibility (AF/atrial flutter, lasting > or = 10 minutes) was assessed using burst pacing at an output of 20 mA down to refractoriness from the coronary sinus and both atrial appendages. RESULTS: In 42 patients (57%), PV isolation restored sinus rhythm and rendered AF noninducible. In the 32 patients with persistent or inducible AF after PV isolation, a single linear lesion achieved noninducibility in 20, whereas two linear lesions were required in 12 and resulted in conversion to sinus rhythm and noninducibility in 10. Using this stepwise approach, a total of 69 patients (93%) were rendered noninducible. During follow-up of 18 +/- 4 months, 67 patients (91%) were free from arrhythmia without antiarrhythmic drugs. Repeat procedures were performed in 23 patients: repeat ablation was required to consolidate prior targets in 15 patients (20%), and "new" linear lesions, which were not predicted by inducibility during the index procedure, were required in 8 (11%). CONCLUSION: Noninducibility can be used as an endpoint for determining the subset of patients with paroxysmal AF who require additional linear lesions after PV isolation. This tailored approach is effective in 91% of patients while preventing delivery of unnecessary linear lesions.
Authors:
Pierre Jaïs; Mélèze Hocini; Prashanthan Sanders; Li-Fern Hsu; Yoshihide Takahashi; Martin Rotter; Thomas Rostock; Frédéric Sacher; Jacques Clementy; Michel Haissaguerre
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  3     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-30     Completed Date:  2006-06-05     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  140-5     Citation Subset:  IM    
Affiliation:
Hôpital Haut-Lévèque and Université Victor Ségalen, Bordeaux II, Bordeaux, France. pierre.jais@chu-bordeaux.fr
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Atrial Fibrillation / physiopathology,  surgery*
Catheter Ablation*
Electrophysiologic Techniques, Cardiac
Female
Humans
Male
Middle Aged
Prospective Studies
Recurrence
Reoperation
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections
Comment In:
Heart Rhythm. 2006 Feb;3(2):146-7   [PMID:  16443527 ]

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


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