title: Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation.
abstract: BACKGROUND
  Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared.
  
  
  RESULTS
  Of 80 consecutive patients with symptomatic PAF (age, 52+/-10 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left- and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 156+/-45 and 50+/-17 minutes for SOCA and 149+/-33 and 39+/-12 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of symptomatic PAF when not taking antiarrhythmic drug therapy (P=0.02). Among the variables of age, sex, duration and frequency of PAF, ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size and the SOCA technique were independent predictors of recurrent PAF. The only complication was left atrial flutter in a patient who underwent LACA.
  
  
  CONCLUSIONS
  In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA.
authors.affiliation: Division of Cardiology, University of Michigan, Ann Arbor, USA. oralh@umich.edu
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Christoph
authors.initials: C
authors.lastname: Scharf
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Burr
authors.initials: B
authors.lastname: Hall
authors.forename: Peter
authors.initials: P
authors.lastname: Cheung
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Srikar
authors.initials: S
authors.lastname: Veerareddy
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome