Pulmonary vein isolation and linear lesions in atrial fibrillation ablation.
BACKGROUND
Various strategies have been used for atrial fibrillation (AF) ablation. It is unclear whether adding linear lesions to pulmonary vein (PV) isolation has significant advantages.


OBJECTIVE
We assessed the clinical benefit of adding linear lesions in patients undergoing PV isolation for AF.


METHODS
One hundred patients (63 male and 37 female; mean age of 59 +/- 11 years) with documented paroxysmal AF were included in the study. Patients were randomized into two groups. The first group underwent PV isolation alone. The second group underwent PV isolation and had two linear lesions created; one line between the superior PVs, and a second line from the left inferior PV to the mitral valve annulus. Patients' clinical progress after the ablation was evaluated and compared at 1, 3, and 9 months after their respective ablation procedures.


RESULTS
The linear lesions group maintained sinus rhythm and had fewer symptoms than the lone PV isolation group (86 vs. 58%, respectively) (p < 0.05) at 1 month. At 9 months, when patients who reverted to AF underwent additional management to regain sinus rhythm (90 vs. 82%, respectively) (p = NS), there was no statistical difference between the groups regarding the use of antiarrhythmics, the need for electrical cardioversion, and subjective improvement.


CONCLUSIONS
The addition of linear lesions to PV isolation more effectively achieved sinus rhythm initially and fewer patients required additional management to maintain their rhythm when compared to patients who underwent lone PV isolation. However, at 9 months, the overall results were similar in both groups.
Sheikh
Imran
I
Electrophysiology Laboratories, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, WI, USA.
Krum
David
D
Cooley
Ryan
R
Dhala
Anwer
A
Blanck
Zalmen
Z
Bhatia
Atul
A
Nangia
Vikram
V
Akhtar
Masood
M
Sra
Jasbir
J
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011667:Pulmonary Veins
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone