title: A tailored approach to catheter ablation of paroxysmal atrial fibrillation.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA. oralh@umich.edu
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Sundar
authors.initials: S
authors.lastname: Sankaran
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Reich
authors.forename: Petar
authors.initials: P
authors.lastname: Igic
authors.forename: Darryl
authors.initials: D
authors.lastname: Elmouchi
authors.forename: David
authors.initials: D
authors.lastname: Tschopp
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Sujoya
authors.initials: S
authors.lastname: Dey
authors.forename: Alan
authors.initials: A
authors.lastname: Wimmer
authors.forename: Kristina
authors.initials: K
authors.lastname: Lemola
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: 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