title: Catheter-induced linear lesions in the left atrium in patients with atrial fibrillation: an electroanatomic study.
abstract: OBJECTIVE
  In this study using radiofrequency current and the electroanatomic mapping system CARTO, four line designs were tested in 84 patients suffering from drug-refractory atrial fibrillation (AFib).
  
  
  BACKGROUND
  Prevention of AFib by trigger elimination within the pulmonary veins (PVs) has been recently reported, but the success may be lesser in patients with chronic AFib or large atria requiring linear lesion deployment.
  
  
  METHODS
  Type A encircled the ostia of all four PVs with a connection to the mitral annulus (MA). In type B, three lines connected anatomic barriers. Type C encircled both septal and lateral PVs with connections between PVs and to the MA. Type D encircled PVs only. In the initial 12 patients (type D/1), line validation was performed without, and in 23 patients (type D/2) with, an additional catheter inside the encircled PVs.
  
  
  RESULTS
  The ability to achieve completeness of all intended lines was 5% in type A, 21% in type B, 29% in C, 66% in type D/1, and 61% in type D/2. This resulted in stable sinus rhythm in 19% (4/21 patients) in type A, 32% (6/19 patients) in type B, 50% (7/14 patients) in type C, 58% (7/12 patients) in type D/1, and 65% (15/23 patients) in type D/2, respectively, over a mean follow-up of 620 +/- 376 days. Besides thromboembolic events (one stroke and one transient ischemic attack), total occlusion of a PV was a major complication in one patient, and acute tamponade in two patients.
  
  
  CONCLUSIONS
  Complete lesions in the left atrium were difficult to achieve using conventional radiofrequency current technology, but were associated with sinus rhythm in 74% of patients during long-term follow-up, whereas incomplete lesions led mostly to recurrences of AFib or gap-related atrial tachycardia.
authors.affiliation: II. Med. Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ernst
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Felix
authors.initials: F
authors.lastname: Löber
authors.forename: Matthias
authors.initials: M
authors.lastname: Antz
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome