title: Left atrial and pulmonary vein ostial ablation as a new treatment for curing persistent atrial fibrillation.
abstract: BACKGROUND
  Segmental pulmonary vein (PV) isolation has been performed to eliminate paroxysmal atrial fibrillation (AF). However, this technique is not effective in most patients with persistent AF.
  
  
  RESULTS
  Left atrial catheter ablation (LACA) was performed by encircling the left- and right-sided PV 1-2 cm from the ostia, guided by an electroanatomical mapping system in 16 patients with persistent AF (>1 month). Twelve patients (75%) had a history of unsuccessful transthoracic cardioversion and prophylactic antiarrhythmic drugs. Ablation lines were also created in the mitral isthmus and posterior LA. PV isolation was also performed for each PV if there were residual PV potentials after the LACA. After LACA, 38 PV (59%) were completely isolated, and complete PV isolation was achieved with only a few radiofrequency energy applications (2.7+/-2.0 min) on a narrow area of the PV ostium (24+/-15%) in the remaining PV. The mean procedure time was 200+/-38 min. During the follow-up period (17+/-3 months), 12 patients (75%) had normal sinus rhythm and were free of symptomatic AF with (n = 10) or without antiarrhythmic drugs (n = 2). One patient had a stroke just after the procedure. No other complications including PV narrowing (>50%) occurred.
  
  
  CONCLUSIONS
  This approach was effective in persistent AF, however, concomitant use of antiarrhythmic drugs was often required.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. tada.h@cvc.pref.gunma.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurosaki
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ito
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Minoru
authors.initials: M
authors.lastname: Yamada
authors.forename: Kohei
authors.initials: K
authors.lastname: Miyaji
authors.forename: Tohru
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yoshimura
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography