title: Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome.
abstract: OBJECTIVE
  To evaluate the contribution of the posterior left atrium (LA) to chronic atrial fibrillation (AF).
  
  
  RESULTS
  Twenty-seven patients with chronic-AF were studied. After pulmonary vein (PV) isolation, the posterior-LA was isolated by ablation joining the right- and left-PVs using an irrigated-tip catheter. Isolation was demonstrated by absent/dissociated posterior-LA activity and the inability to pace the region. Ablation impact was determined by the effect on cycle length (CL) and AF termination. Posterior-LA isolation was achieved using 35 +/- 12 min of radiofrequency with total fluoroscopic and procedural durations of 64 +/- 16 and 199 +/- 46 min, resulting in abolition of electrograms (n = 21) or autonomous activity (n = 6; CL 820 +/- 343 ms). AFCL increased from 156 +/- 28 ms to 162 +/- 27 ms with PV-isolation and to 175 +/- 32 ms by posterior-LA exclusion (P < 0.0001). AF persisted in all after PV-isolation and terminated in 5 (19%) during posterior-LA-isolation. After 10 +/- 6 months, 12 patients developed atrial tachycardia (four) or AF (eight); four underwent repeat posterior-LA-isolation, while the others required additional ablation/antiarrhythmics. After 21 +/- 5 months, 17 (63%) were in sinus rhythm following posterior-LA-isolation.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of complete posterior-LA exclusion by catheter ablation. This strategy results in maintenance of sinus rhythm in 63% at 2 years follow-up.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux-II, Bordeaux, France. prash.sanders@adelaide.edu.au
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Fréderic
authors.initials: F
authors.lastname: Sacher
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Martin
authors.initials: M
authors.lastname: Rotter
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Chrishan J
authors.initials: CJ
authors.lastname: Nalliah
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation; D002908:Chronic Disease; D004594:Electrophysiology; D005260:Female; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome