Trigger activity more than three years after left atrial linear ablation without pulmonary vein isolation in patients with atrial fibrillation.
OBJECTIVE
The aim of this study was to analyze trigger activity in the long-term follow-up after left atrial (LA) linear ablation.


BACKGROUND
Interventional strategies for curative treatment of atrial fibrillation (AF) are targeted at the triggers and/or the maintaining substrate. After substrate modification using nonisolating linear lesions, the activity of triggers is unknown.


METHODS
With the LA linear lesion concept, 129 patients were treated using intraoperative ablation with minimal invasive surgical techniques. Contiguous radiofrequency energy-induced lesion lines involving the mitral annulus and the orifices of the pulmonary veins without isolation were placed under direct vision.


RESULTS
After a mean follow-up of 3.6 +/- 0.4 years, atrial ectopy, atrial runs, and reoccurrence of AF episodes were analyzed by digital 7-day electrocardiograms in 30 patients. Atrial ectopy was present in all patients. Atrial runs were present in 25 of 30 patients (83%), with a median number of 9 runs per patient/week (range 1 to 321) and a median duration of 1.2 s/run (range 0.7 to 25), without a significant difference in atrial ectopy and atrial runs between patients with former paroxysmal (n = 17) or persistent AF (n = 13). Overall, 87% of all patients were completely free from AF without antiarrhythmic drugs.


CONCLUSIONS
A detailed rhythm analysis late after specific LA linear lesion ablation shows that trigger activity remains relatively frequent but short and does not induce AF episodes in most patients. The long-term success rate of this concept is high in patients with paroxysmal or persistent AF.
Tanner
Hildegard
H
University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany. hilditanner@pop.agri.ch
Hindricks
Gerhard
G
Kobza
Richard
R
Dorszewski
Anja
A
Schirdewahn
Petra
P
Piorkowski
Christopher
C
Gerds-Li
Jin-Hong
JH
Kottkamp
Hans
H
D001281:Atrial Fibrillation / Q000601:surgery*; D018880:Atrial Premature Complexes / Q000175:diagnosis; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors