Segmental Pulmonary Vein Antrum Isolation Using the "Large-Size" Lasso Catheter in Patients With Atrial Fibrillation

Abstract

lthough the efficiency of ostial pulmonary vein isolation (OPVI) to suppress the occurrence of atrial fibrillation (AF) is well established, 1 the relatively frequent recurrence of AF 2 and the appearance of pulmonary vein (PV) stenosis 3 have recently been highlighted as major limitations of this approach. Because the isolation of the PVs, together with their surrounding tissue, might overcome these problems, at least in part, several approaches using linear ablation techniques, such as circumferential linear ablation using electroanatomical mapping 4 or circumferential 2×2 PV isolation (PVI), 5 have so far been developed; however, there have only been a few reports describing the effects of segmental radiofrequency (RF) application outside the PV ostium. 6 In this report, we describe the feasibility and efficiency of performing segmental PV antrum isolation (PVAI) using large-sized Lasso catheters compared with the conventional OPVI method. Methods Patient PopulationThis study included 187 consecutive patients who underwent PV mapping and ablation for multidrug-resistant AF (paroxysmal AF: 120 patients; persistent AF: 67 patients) and thereafter were observed for at least 12 months Circulation Journal Vol.71, May 2007 (Table 1). We defined persistent AF as an episode of AF that lasted for more than 14 days and required cardioversion to restore sinus rhythm (SR). Cases of long-lasting persistent AF for more than 12 months were not included. The study group comprised 144 males and 43 females with a mean age of 55±8 years. Forty-five patients had evidence of cardiovascular diseases: 32 had hypertension, 9 had coronary artery disease, 5 had dilated cardiomyopathy, and 3 had mitral valve regurgitation. Two types of mapping and ablation techniques were used for PVI. In Group 1, which comprised the first 70 consecutive patients (52 males, mean age: 52.0±10.3 years), each PV was disconnected from the left atrium (LA) at its ostium. In Group 2, which included the subsequent 117 patients (92 males, mean age: 53.2±9.8 years), PVI was performed at its antrum, targeting not only the PV itself but also the surrounding tissues. All patients underwent the ablation procedure and subsequent observaCirc J 2007; 71: 753 -760 (Received October 20, 2006; revised manuscript received January 24, 2007; accepted February 22, 2007 Background The limited efficacy and complications of segmental ostial pulmonary vein isolation (PVI) for treating atrial fibrillation (AF) have been discussed so, in the present study the feasibility and efficiency of performing segmental pulmonary vein (PV) antrum isolation to treat AF were assessed. Methods and Results A total of 187 patients with drug-refractory AF (paroxysmal 120, persistent 67) underwent segmental PVI guided by circumferential 20-electrode catheters (Lasso). Radiofrequency (RF) current was delivered either at the ostium using a regular Lasso (15-20 mm in diameter, 70 patients: Group 1) or at the antrum using a larger Lasso (25-30 mm in diameter, 117 patients: Group 2). A significantly ...

Noncontact Mapping-Guided Catheter Ablation of Atrial Fibrillation

“…[1][2][3][4] To improve the clinical outcome, additional linear ablation to modify the substrate of AF has been proposed, 5-7 and we recently described an alternative approach of complete isolation of the posterior left atrium (LA), including all the PVs, for treating AF, namely the Box isolation. 8 However, this procedure is technically challenging because of variant atrial conductions, incomplete lesion lines or recovered conduction gaps being proarrhythmic.…”

Effect of Left Atrial Ablation on the Quality of Life in Patients With Atrial Fibrillation

“…[3][4][5][6][7][8] Using the Short-Form-36 questionnaire (SF-36), some previous reports showed a significant improvement in the QOL following the CA in patients with AF. 9,10 In this study, we used a questionnaire specific for AF, and assessed the clinical course of the QOL after the CA over a 6-month follow-up period in patients with both paroxysmal and chronic AF.…”

Efficacy of Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients With a Brugada Electrocardiogram

“…We demonstrated that PVI was highly effective and safe in AF patients with a Brugada ECG, similar to other patients with idiopathic AF. [4][5][6][7][8]12 These findings suggest that PVI is a potential first-line therapy for symptomatic AF in patients with a Brugada ECG.…”