Left atrial and pulmonary vein ostial ablation as a new treatment for curing persistent atrial fibrillation.
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.
Tada
Hiroshi
H
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. tada.h@cvc.pref.gunma.jp
Kurosaki
Kenji
K
Ito
Sachiko
S
Naito
Shigeto
S
Yamada
Minoru
M
Miyaji
Kohei
K
Hashimoto
Tohru
T
Yoshimura
Yuko
Y
Nogami
Akihiko
A
Oshima
Shigeru
S
Taniguchi
Koichi
K
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