A tailored approach to catheter ablation of paroxysmal atrial fibrillation.
BACKGROUND
Because the genesis of atrial fibrillation (AF) is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set.


RESULTS
Catheter ablation was performed in 153 consecutive patients (mean age, 56+/-11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19% of patients and was still present in 10% at >12 weeks of follow-up. A repeat ablation procedure was performed in 18% of patients. During a mean follow-up of 11+/-4 months, 77% of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2% of procedures.


CONCLUSIONS
A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal AF in approximately 80% of patients.
Oral
Hakan
H
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA. oralh@umich.edu
Chugh
Aman
A
Good
Eric
E
Sankaran
Sundar
S
Reich
Stephen S
SS
Igic
Petar
P
Elmouchi
Darryl
D
Tschopp
David
D
Crawford
Thomas
T
Dey
Sujoya
S
Wimmer
Alan
A
Lemola
Kristina
K
Jongnarangsin
Krit
K
Bogun
Frank
F
Pelosi
Frank
F
Morady
Fred
F
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D001282:Atrial Flutter / Q000209:etiology / Q000503:physiopathology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D016896:Treatment Outcome