Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation.
BACKGROUND
Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently been described as a new anatomic approach for atrial fibrillation (AF).


RESULTS
We treated 251 consecutive patients with paroxysmal (n=179) or permanent (n=72) AF. Circular PV lesions were deployed transseptally during sinus rhythm (n=124) or AF (n=127) using 3D electroanatomic guidance. Procedures lasted 148+/-26 minutes. Among 980 lesions surrounding individual PVs (n=956) or 2 ipsilateral veins with close openings or common ostium (n=24), 75% were defined as complete by a bipolar electrogram amplitude <0.1 mV inside the lesion and a delay >30 ms across the line. The amount of low-voltage encircled area was 3594+/-449 mm(2), which accounted for 23+/-9% of the total left atrial (LA) map surface. Major complications (cardiac tamponade) occurred in 2 patients (0.8%). No PV stenoses were detected by transesophageal echocardiography. After 10.4+/-4.5 months, 152 patients with paroxysmal AF (85%) and 49 with permanent AF (68%) were AF-free. Patients with and without AF recurrence did not differ in age, AF duration, prevalence of heart disease, or ejection fraction, but the LA diameter was significantly higher (P<0.001) in permanent AF patients with recurrence. The proportion of PVs with complete lesions was similar between patients with and without recurrence, but the latter had larger low-voltage encircled areas after radiofrequency (expressed as percent of LA surface area; P<0.001).


CONCLUSIONS
Circumferential PV ablation is a safe and effective treatment for AF. Its success is likely due to both PV trigger isolation and electroanatomic remodeling of the area encompassing the PV ostia.
Pappone
C
C
Department of Cardiology, San Raffaele University Hospital, Milan, Italy. carlo.pappone@hsr.it
Oreto
G
G
Rosanio
S
S
Vicedomini
G
G
Tocchi
M
M
Gugliotta
F
F
Salvati
A
A
Dicandia
C
C
Calabrò
M P
MP
Mazzone
P
P
Ficarra
E
E
Di Gioia
C
C
Gulletta
S
S
Nardi
S
S
Santinelli
V
V
Benussi
S
S
Alfieri
O
O
D001281:Atrial Fibrillation / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome