Randomized comparison of encircling and nonencircling left atrial ablation for chronic atrial fibrillation.
BACKGROUND
Left atrial (LA) circumferential ablation has been reported to eliminate atrial fibrillation (AF). Whether an ablation without encirclement of the pulmonary veins (PVs) is as effective as LA circumferential ablation is not clear.


OBJECTIVE
The purpose of this study was to compare the efficacy of LA circumferential ablation and nonencircling linear ablation in patients with chronic AF.


METHODS
Eighty patients with chronic AF were randomized to undergo LA circumferential ablation (n = 40) or nonencircling linear ablation (n = 40). In LA circumferential ablation, the PVs were encircled, with additional lines made in the mitral isthmus and posterior wall or roof. In nonencircling linear ablation, 4 +/- 1 ablation lines were created through areas of complex electrograms, with lines in the roof (38), anterior wall (36), septum (40), mitral isthmus (32), and posterior annulus (6). The endpoint of LA circumferential ablation and nonencircling linear ablation was voltage abatement.


RESULTS
LA flutter occurred in 15% after LA circumferential ablation and in 18% after nonencircling linear ablation (P = .8). A repeat ablation procedure was performed for recurrent AF in 7 and 11 patients or for atrial flutter in 6 and 4 patients after LA circumferential ablation and nonencircling linear ablation, respectively (P = .8). At 9 +/- 4 months, the prevalence of AF was 28% in the LA circumferential ablation and 25% in the nonencircling linear ablation group (P = .8). Sixty-eight percent and 60% of patients were in sinus rhythm and free of AF and atrial flutter in the absence of antiarrhythmic drug therapy after LA circumferential ablation and nonencircling linear ablation, respectively (P = .5). There were no complications.


CONCLUSIONS
Nonencircling linear ablation and LA circumferential ablation are equally efficacious in eliminating chronic AF. However, the advantage of nonencircling linear ablation is that it eliminates the need for ablation along the posterior wall of the LA. Therefore, nonencircling linear ablation may avoid the small but real risk of atrioesophageal fistula formation associated with LA circumferential ablation.
Oral
Hakan
H
Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. oralh@umich.edu
Chugh
Aman
A
Good
Eric
E
Igic
Petar
P
Elmouchi
Darryl
D
Tschopp
David R
DR
Reich
S Scott
SS
Bogun
Frank
F
Pelosi
Frank
F
Morady
Fred
F
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D016896:Treatment Outcome