Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation

Knecht, Sébastien; Hocini, Mélèze; Wright, Matthew; Lellouche, Nicolas; O’Neill, Mark; Matsuo, Seiichiro; Nault, Isabelle; Chauhan, Vijay S.; Makati, Kevin J.; Bevilacqua, Michela; Lim, Kang‐Teng; Sacher, Frédéric; Deplagne, Antoine; Derval, Nicolas; Bordachar, Pierre; Jaı̈s, Pierre; Clémenty, Jacques; Haı̈ssaguerre, Michel

doi:10.1093/eurheartj/ehn302

Cited by 237 publications

(230 citation statements)

References 44 publications

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“…Namely, postprocedural rate of atrial tachycardia was 2-2.5 times higher among patients with incomplete linear lesions [202].…”

Section: Phrenic Nerve Injurymentioning

confidence: 89%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

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“…Namely, postprocedural rate of atrial tachycardia was 2-2.5 times higher among patients with incomplete linear lesions [202].…”

Section: Phrenic Nerve Injurymentioning

confidence: 89%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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“…In recurrent AFparox ectopic focal activity is thought to be local and limited to one or a few sites. On the contrary in AFpers there tend to be multiple ectopic sites throughout the atria and advanced damage of atrial myocardium (more susceptible substrate) [10][11][12][13]. Large left atrial (LA) size was found to be a predictor of recurrence of AF after electrical or pharmacological cardio-version as well as after ablative treatment [14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2013

J Cardiobiol

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Purpose: Pulmonary vein isolation (PVI) is established as interventional treatment in atrial fibrillation (AF). Recent studies suggest that atrial reservoir function (preload) is involved in initiation of paroxysmal AF (AFparox) and conduit function (after-load) may be crucial in persistent AF (AFpers). Methods:We enrolled 336 consecutive patients scheduled for PVI (age 60±10 years). Point-to-point radiofrequency ablation was used in the majority of cases. Success was defined as a minimum of 3 months (median 12 months) follow-up as absence of recurrence of AF in any Holter ECG since PVI. in particular pulmonary vein isolation (PVI), can be considered as an early option in the management of patients with AF [5]. Success rates of the initial ablation procedure depend on the definition of success; they vary between 60 and 85% for AFparox and are lower for persistent AF (AFpers) [3,[6][7][8][9].The initiation of AF requires both a trigger and a susceptible substrate. In recurrent AFparox ectopic focal activity is thought to be local and limited to one or a few sites. On the contrary in AFpers there tend to be multiple ectopic sites throughout the atria and advanced damage of atrial myocardium (more susceptible substrate) [10][11][12][13]. Large left atrial (LA) size was found to be a predictor of recurrence of AF after electrical or pharmacological cardio-version as well as after ablative treatment [14][15][16][17]. The prognostic value of volume seems to be absent in AFparox, however [18].LA function comprises three phases: reservoir, conduit and active contraction phase [19]. LA-active function increases with slight volume load as long as LA structural dilatation is limited [19,20]. Thus, in early LA dysfunction as expected in AFparox systolic LA dimensions are ambiguous, because an increased systolic volume may reflect increased loading and/or size (history of dilatation).Recent studies suggest that preserved atrial reservoir function related to preload is a predictor of success [21]. Impairment of atrial reservoir function and poor long-term success of PVI in small left atria was related to enhanced fibrosis [22]. Whereas conduit function related to after-load may become increasingly important for PVI success in large atria with poor emptying.Thus, we tested the hypothesis that in AFparox atrial reservoir function and in AFpers residual conduit function is crucial for success of PVI by an analysis in the function-size plane in a retrospective study in our PVI data-base. As second end points we wanted to identify echocardiographic parameters potentially predicting recurrence of AF after PVI and elucidate the impact of body mass index (BMI) in this context.

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“…These approaches included ablation of complex-fractionated atrial electrograms (CFAe), targeting local cycle length (frequency) gradients, linear ablation between fixed anatomical structures, isolation of the superior vena cava, ablation of the coronary sinus or ligament of Marshall, electrical isolation of the left atrial appendage, targeting ganglionated plexi, or a combination of these approaches as in the step-wise ablation approach. [21][22][23][24][25][26][27][28] end points of these ablation strategies can be variable. When an anatomic ablation strategy such as linear ablation and isolation of other thoracic veins is pursued, termination often is not sought after as a procedural end point.…”

Section: Catheter Ablationmentioning

confidence: 99%