title: Long-term follow-up of right atrial ablation in patients with atrial fibrillation:.
abstract: BACKGROUND
  The aim of this study was to evaluate the efficacy and the impact on quality of life of a new ablative approach to the right atrium in patients with atrial fibrillation (AF).
  
  
  RESULTS
  Seventy-four symptomatic patients with paroxysmal (n = 49) or permanent (n = 25) refractory AF underwent radiofrequency ablation. A nonfluoroscopic electroanatomic mapping system was used to perform the following lesions: (1) an isthmus line between the tricuspid annulus and the inferior vena cava; (2) a posterior intercaval line from the superior vena cava and the inferior vena cava; (3) a septal line from the superior vena cava to the fossa ovalis, proceeding to the coronary sinus ostium where a circumferential line around the ostium was performed, and then on to the inferior vena cava; and (4) a transversal lesion connecting the posterior intercaval and the septal lesions. In addition, electrical disconnection of the superior vena cava was performed. There were no complications. Postablation remapping showed the absence of discrete electrical activity inside and just around the ablation lines. Electrical disconnection of the superior vena cava was obtained in all patients. After 21 +/- 6 months, 49 patients (66%) had stable sinus rhythm with continuation of the previous antiarrhythmic drug therapy, 13 patients (18%) were considered improved, and 12 (16%) received no benefit (unsuccessful procedure). After ablation, quality of life was significantly improved, reaching the levels of the general Italian population. Ejection fraction and the extent of the low-voltage area were found by multivariate analysis to be independent predictors of AF recurrence.
  
  
  CONCLUSIONS
  The results of the present study suggest that this ablative approach in combination with antiarrhythmic drugs is safe and effective in treating AF, leading to a marked increase in quality of life in patients with refractory AF.
authors.affiliation: Department of Cardiac Diseases, San Filippo Neri Hospital, Rome, Italy. leonardo.calo@tin.it
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calò
authors.forename: Filippo
authors.initials: F
authors.lastname: Lamberti
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Loricchio
authors.forename: Antonio
authors.initials: A
authors.lastname: Castro
authors.forename: Shlomo
authors.initials: S
authors.lastname: Shpun
authors.forename: Augusto
authors.initials: A
authors.lastname: Boggi
authors.forename: Claudio
authors.initials: C
authors.lastname: Pandozi
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D012647:Self-Assessment; D016896:Treatment Outcome