TY - JOUR
T1 - Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation
T2 - Consequences of wide atrial encircling of the pulmonary veins
AU - Hocini, Mélèze
AU - Sanders, Prashanthan
AU - Jaïs, Pierre
AU - Hsu, Li Fern
AU - Weerasoriya, Rukshen
AU - Scavée, Christophe
AU - Takahashi, Yoshihide
AU - Rotter, Martin
AU - Raybaud, Florence
AU - Made, Laurent
AU - Clémenty, Jacques
AU - Haïssaguerre, Michel
N1 - Funding Information:
P.S. is supported by the Neil Hamilton Fairley Fellowship from the National Health and Medical Research Council of Australia and the Ralph Reader Fellowship from the National Heart Foundation of Australia. M.R. is supported by the Swiss National Foundation for Scientific Research, Bern, Switzerland. This paper was previously presented at the 24th Annual Scientific Sessions of the North American Society of Pacing and Electrophysiology, Washington, May 2003, and published in abstract form (Pacing Clin Electrophysiol 2003;26:941).
PY - 2005/4
Y1 - 2005/4
N2 - Aims: Anatomical and wide atrial encircling of the pulmonary veins (PVs) has been proposed as a cure of atrial fibrillation (AF). We evaluated the acute achievement of electrical PV isolation using this approach. In addition, the consequences of wide encircling of the PVs with isolation were assessed. Methods and results: Twenty patients with paroxysmal AF were studied. Anatomically guided ablation was performed utilizing the CARTO system to deliver coalescent lesions circumferentially around each PV to produce a voltage reduction to <0.1 mV, with the operator blinded to recordings of circumferential PV mapping. After achieving the anatomical endpoint, the incidence of residual conduction and the amplitude and conduction delay of residual PV potentials were determined. Electrical isolation of the PV was then performed and the residual far-field potentials evaluated. Individual PV ablation was performed in all PVs. Anatomically guided PV ablation was performed for 47.3 ± 11 min, after which 44 (55%) PVs were electrically isolated. In the remaining 45%, despite abolition of the local potential at the ablation site, PV potentials [amplitude 0.2 mV (range 0.09-0.75) and delay of 50.3 ± 12.6 ms] were identified by circumferential mapping. After electrical isolation (12.2 ± 11.7 min ablation), 55 (69%) PVs demonstrated far-field potentials; with a greater incidence (P = 0.015) and amplitude (P = 0.021) on the left compared with the right PVs. At 13.2 ± 8.3 months follow-up, 13 patients (65%) remained arrhythmia-free without anti-arrhythmics. In four patients (20%), spontaneous sustained left atrial macrore-entry required re-mapping and ablation. Macrore-entry was observed to utilize regions around or bordering the previous ablation as its substrate. Conclusion: Anatomically guided circumferential PV ablation results in apparently coalescent but electrically incomplete lesions with residual conduction in 45% of PVs. Wide encircling of the PVs was associated with left atrial macrore-entry in 20% of patients.
AB - Aims: Anatomical and wide atrial encircling of the pulmonary veins (PVs) has been proposed as a cure of atrial fibrillation (AF). We evaluated the acute achievement of electrical PV isolation using this approach. In addition, the consequences of wide encircling of the PVs with isolation were assessed. Methods and results: Twenty patients with paroxysmal AF were studied. Anatomically guided ablation was performed utilizing the CARTO system to deliver coalescent lesions circumferentially around each PV to produce a voltage reduction to <0.1 mV, with the operator blinded to recordings of circumferential PV mapping. After achieving the anatomical endpoint, the incidence of residual conduction and the amplitude and conduction delay of residual PV potentials were determined. Electrical isolation of the PV was then performed and the residual far-field potentials evaluated. Individual PV ablation was performed in all PVs. Anatomically guided PV ablation was performed for 47.3 ± 11 min, after which 44 (55%) PVs were electrically isolated. In the remaining 45%, despite abolition of the local potential at the ablation site, PV potentials [amplitude 0.2 mV (range 0.09-0.75) and delay of 50.3 ± 12.6 ms] were identified by circumferential mapping. After electrical isolation (12.2 ± 11.7 min ablation), 55 (69%) PVs demonstrated far-field potentials; with a greater incidence (P = 0.015) and amplitude (P = 0.021) on the left compared with the right PVs. At 13.2 ± 8.3 months follow-up, 13 patients (65%) remained arrhythmia-free without anti-arrhythmics. In four patients (20%), spontaneous sustained left atrial macrore-entry required re-mapping and ablation. Macrore-entry was observed to utilize regions around or bordering the previous ablation as its substrate. Conclusion: Anatomically guided circumferential PV ablation results in apparently coalescent but electrically incomplete lesions with residual conduction in 45% of PVs. Wide encircling of the PVs was associated with left atrial macrore-entry in 20% of patients.
KW - Ablation
KW - Atrial fibrillation
KW - Atrial flutter
KW - Electrophysiology
KW - Pulmonary veins
UR - http://www.scopus.com/inward/record.url?scp=20244387978&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehi096
DO - 10.1093/eurheartj/ehi096
M3 - Article
C2 - 15637083
AN - SCOPUS:20244387978
SN - 0195-668X
VL - 26
SP - 696
EP - 704
JO - European heart journal
JF - European heart journal
IS - 7
ER -