Small or Large Isolation Areas Around the Pulmonary Veins for the Treatment of Atrial Fibrillation?
Open Access
- 19 June 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 115 (24), 3057-3063
- https://doi.org/10.1161/circulationaha.107.690578
Abstract
Background— Pulmonary vein (PV) isolation is a promising new treatment for atrial fibrillation (AF). We hypothesized that isolation of large areas around both ipsilateral PVs with verification of conduction block is more effective than the isolation of each individual PV. Methods and Results— A total of 110 patients, 67 with paroxysmal AF and 43 with persistent AF, were randomly assigned to undergo either isolation of each individual PV or isolation of large areas around both ipsilateral PVs. The isolation of each individual PV was an electrophysiologically guided, ostial segmental ablation with a 64-pole basket catheter or a 20-pole circular mapping catheter (group I). Isolation of large areas was performed around the 2 ipsilateral veins with a nonfluoroscopic navigation system and a circular 20-pole mapping catheter for verification of conduction block (group II). In both groups, an irrigated-tip ablation catheter (25 to 35 W) was used to achieve complete isolation. Procedure and ablation times were longer in group II, whereas fluoroscopic time was significantly shorter ( P ≤0.001). After a follow-up period of 15±4 months, 27 patients in group I (49%) and 37 patients in group II (67%) remained free of symptoms of AF and had no AF or atrial flutter during repetitive Holter monitoring without antiarrhythmic drug treatment after a single procedure ( P ≤0.05). Conclusions— The rate of success was significantly higher and fluoroscopy times were significantly lower in the group with large isolation areas around both ipsilateral PVs than in those who underwent individual PV isolation.Keywords
This publication has 16 references indexed in Scilit:
- Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter TechniqueCirculation, 2005
- Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial FibrillationCirculation, 2005
- Catheter Location, Tracking, Cardiac Chamber Geometry Creation, and Ablation Using Cutaneous PatchesJournal of Interventional Cardiac Electrophysiology, 2005
- Complete Isolation of Left Atrium Surrounding the Pulmonary VeinsCirculation, 2004
- Changes in Atrial Fibrillation Cycle Length and Inducibility During Catheter Ablation and Their Relation to OutcomeCirculation, 2004
- Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial FibrillationCirculation, 2004
- Feasibility and Safety of Pulmonary Vein Isolation Using a New Mapping and Navigation System in Patients With Refractory Atrial FibrillationCirculation, 2003
- Catheter Ablation for Paroxysmal Atrial FibrillationCirculation, 2003
- Intra-Atrial Pressure Increases Rate and Organization of Waves Emanating From the Superior Pulmonary Veins During Atrial FibrillationCirculation, 2003
- Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary VeinsThe New England Journal of Medicine, 1998