title: Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patients with atrial fibrillation.
abstract: OBJECTIVE
  To evaluate the feasibility and outcome of ablation to transect the anterior left atrium (LA) in patients with atrial fibrillation (AF).
  
  
  BACKGROUND
  While the Maze procedure is effective in maintaining sinus rhythm in patients with AF, it is associated with significant morbidity. This prospective clinical study evaluates the feasibility and consequences of limited LA linear ablation to transect the anterior LA in patients with AF.
  
  
  METHODS
  Twenty-four patients (51.2 +/- 7.3 years) with paroxysmal (n = 16) or chronic (n = 8) AF resistant to pulmonary vein (PV) isolation were studied. To transect the anterior LA, linear ablation was performed joining the superior PVs; this line was then connected to the anterior mitral annulus. Pulmonary vein isolation and cavotricuspid isthmus ablation were performed in all cases. Ablation was performed using an irrigated catheter with the endpoint of achieving complete linear block demonstrated by online double potentials, differential pacing techniques, and an activation detour.
  
  
  RESULTS
  Of 20 patients in AF prior to linear ablation, arrhythmia terminated in 12 (60%), including half the patients with chronic AF, during ablation. Despite repeated ablation, complete linear block was achieved in only 14 of 24 patients (58%). Complete linear conduction block resulted in an activation detour around the mitral annulus and PVs with a delay of 158 +/- 30 ms (P = .0001), significantly delayed activation of the lateral LA with prolongation of P-wave duration (P = .002), and characteristic change in P-wave morphology during sinus rhythm (P = .002). Of the 14 with anterior LA transection, 4 (29%) have had regular atrial tachycardias due to macroreentry through recovered gaps. Nine of these 14 (64%) have remained arrhythmia-free without antiarrhythmics compared to 3 of 10 (30%) with incomplete block at 28 +/- 4 months following their last procedure (P = .2).
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of catheter ablation to transect the anterior LA in humans. While being effective in the termination of AF, this configuration of linear lesions is technically challenging to complete, results in significant delayed LA activation, and is associated with modest long-term arrhythmia suppression.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Fréderic
authors.initials: F
authors.lastname: Sacher
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquié
authors.forename: Dipen C
authors.initials: DC
authors.lastname: Shah
authors.forename: Stéphane
authors.initials: S
authors.lastname: Garrigue
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery; D018709:Statistics, Nonparametric; D016896:Treatment Outcome