Left atrium electrical isolation as a complication of catheter ablation of persistent atrial fibrillation

To assess proarrythmogenic effects after different techniques of radiofrequency catheter ablation, 427 patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation (AF) were examined. The patients were randomized into four groups: antral pulmonary vein isolation (PVI) (Group I), PVI plus roof line and mitral isthmus ablation (Group II), anatomic ablation of ganglionated plexuses (GP) of the left atrium (Group III) and GP plus PVI (Group IV). At the end of follow up (34,43,2 months) the largest number of proarrythmogenic effects was observed in Group II, 24,8% (26 patients). In the remaining groups the percentage of proarrythmogenic effects did not exceed 11%, neither was there any significant difference among Groups I, III and IV. Thus, the creation of additional linear lesions in the left atrium is a predictor of proarrythmogenic effects during follow up.

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Nonlinear analysis of right atrial electrograms predicts termination of persistent atrial fibrillation within the left atrium by catheter ablation

Physiological Measurement ◽

10.1088/0967-3334/37/3/347 ◽

2016 ◽

Vol 37 (3) ◽

pp. 347-359 ◽

Cited By ~ 2

Author(s):

Adrian Luca ◽

Andrea Buttu ◽

Etienne Pruvot ◽

Patrizio Pascale ◽

Laurence Bisch ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Nonlinear Analysis ◽

Left Atrium ◽

Persistent Atrial Fibrillation ◽

Right Atrial ◽

Atrial Electrograms

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P962Circumferential pulmonary vein ablation in combination with a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (8.5-year follow-up)

EP Europace ◽

10.1093/europace/euaa162.089 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Kettering

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Pulmonary Vein ◽

Persistent Atrial Fibrillation ◽

Pulmonary Vein Ablation ◽

Group A ◽

Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (> 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.

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Apparent foreign-body-like structure detected in the left atrium after catheter ablation for persistent atrial fibrillation

Biomedical Papers ◽

10.5507/bp.2018.052 ◽

2019 ◽

Vol 163 (2) ◽

pp. 184-186

Author(s):

Tomas Skala ◽

Ondrej Moravec ◽

Martin Hutyra ◽

Zbynek Tudos ◽

Martin Kocher ◽

...

Keyword(s):

Atrial Fibrillation ◽

Foreign Body ◽

Catheter Ablation ◽

Left Atrium ◽

Persistent Atrial Fibrillation

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Inadvertent electrical isolation of the left atrial appendage during catheter ablation of persistent atrial fibrillation

Heart Rhythm ◽

10.1016/j.hrthm.2009.10.036 ◽

2010 ◽

Vol 7 (2) ◽

pp. 173-180 ◽

Cited By ~ 32

Author(s):

Chin Pang Chan ◽

Wai Shun Wong ◽

Satchana Pumprueg ◽

Srikar Veerareddy ◽

Sreedhar Billakanty ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Persistent Atrial Fibrillation ◽

Atrial Appendage ◽

Electrical Isolation

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Comparative efficacy and safety of different catheter ablation strategies for persistent atrial fibrillation: a network meta-analysis of randomized clinical trials

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcab066 ◽

2021 ◽

Author(s):

Andrea Saglietto ◽

Andrea Ballatore ◽

Fiorenzo Gaita ◽

Marco Scaglione ◽

Roberto De Ponti ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Trials ◽

Catheter Ablation ◽

Left Atrium ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Persistent Atrial Fibrillation ◽

Linear Lesions ◽

Procedural Complications ◽

Reduced Risk

Abstract Aims Whereas pulmonary vein isolation (PVI) is the universally agreed target in catheter ablation of paroxysmal atrial fibrillation (AF), an ideal ablation set in persistent AF remains questioned. Aim of this study is to conduct a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing different ablation strategies in persistent AF patients. Methods and results Network meta-analysis was performed in a frequentist framework with the different ablation strategies constituting the competitive arms of interest. Primary efficacy endpoint was recurrences of atrial tachyarrhythmia (AF, atrial flutter, and/or organized atrial tachycardia). Secondary endpoints included major peri-procedural complications, procedure, and fluoroscopy duration. PubMED/MEDLINE and EMBASE databases were searched through June 2020. 2548 records were screened and 57 full-text articles assessed. Eventually 24 RCTs were included, encompassing 3245 patients (median follow-up 15 months, IQR 12–18). Compared to PVI alone, PVI plus linear lesions in the left atrium and elimination of extra-PV sources was the only strategy associated with a reduced risk of arrhythmia recurrence (RR 0.49, 95%CI 0.27–0.88). Most treatment arms were associated with longer procedural time compared with PVI; however, major peri-procedural complications and fluoroscopy time did not differ. Conclusion A comprehensive strategy including PVI, linear lesions in the left atrium, and elimination of extra-PV sources (constrained by a heterogeneous definition across studies) was associated with reduced risk of recurrent atrial tachyarrhythmias compared to PVI alone. All investigated treatment arms yielded similar safety profiles. Further research should rely on enhanced substrate-based approach definitions to solve one of the most evident knowledge gaps in interventional electrophysiology.

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Circumferential pulmonary vein ablation with or without a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (9-year follow-up)

European Heart Journal ◽

10.1093/ehjci/ehaa946.0568 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Kettering

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Pulmonary Vein ◽

Persistent Atrial Fibrillation ◽

Pulmonary Vein Ablation ◽

Group A ◽

Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 240 patients (125 men, 115 women; mean age 70 years (SD ± 15 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96, 102 and 108 months after the ablation procedure. The long-term follow-up data was compared to 240 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-five out of 240 patients (22.9%) in group A and 58 out of 240 patients (24.2%) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 108-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 135/240 patients (56.3%) in group A and in 111/220 patients (46.3%) in group B. In 73/240 patients (30.4%) in group A and 66/240 patients (27.5%) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 32 patients (13.3%) in group A, a recurrence of persistent atrial fibrillation (>48 hours) was revealed by the long-term recordings (group B: 63 patients (26.2%)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up. Funding Acknowledgement Type of funding source: None

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