Effects of circumferential ostial radiofrequency lesions on pulmonary vein activation recorded with a multipolar basket catheter.
OBJECTIVE
Two different ablation procedures are performed to cure patients of atrial fibrillation (AF): (1) the electrophysiological pulmonary vein (PV) isolation, and (2) the anatomical circumferential ablation of all four PV ostia. The aim of this study was to determine the effects of circumferential radiofrequency lesions around the ostia on PV activation.


RESULTS
In 34 patients with drug refractory paroxysmal (N = 22) or persistent (N = 12) AF a 31-mm basket catheter (BC) was introduced transseptally in the PVs. After creating a circumferential ablation line around the PV ostia using a nonfluoroscopic 3D-navigation system, electrical isolation was achieved in 46% of the PVs, and prolongation of conduction time (+39 +/- 34 ms) was observed in 30%. PVs with persistent conduction (54%) were isolated by ablating the remaining conduction pathways using the BC. At 12 months follow-up, 62% of the patients were in stable sinus rhythm without antiarrhythmic drug therapy. Six patients had developed left atrial flutter.


CONCLUSIONS
Anatomically guided, circumferential lesions around the PV ostia resulted in isolation in only 46% of the veins. At 12 months, 62% of the patients were free of AF without antiarrrhythmic drug treatment, however, 6 patients (18%) developed left atrial flutter.
Arentz
Thomas
T
Rhythmologie, Herz-Zentrum, Bad Krozingen, Germany. thomas.arentz@herzzentrum.de
Von Rosenthal
Jörg
J
Weber
Reinhold
R
Bürkle
Gerd
G
Blum
Thomas
T
Stockinger
Jochem
J
Neumann
Franz Josef
FJ
Kalusche
Dietrich
D
D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology / Q000517:prevention & control; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology* / Q000601:surgery*