Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation.
OBJECTIVE
This study evaluates the clinical outcome and incidence of left atrial (LA) macro re-entrant atrial tachycardia (AT) in patients in whom persistent atrial fibrillation (AF) terminated during catheter ablation without the need of roof and mitral lines.


RESULTS
Persistent AF was terminated by ablation in 154 of 180 consecutive patients. AF history was 60 months including 11 months of continuous AF. Patients were divided into two groups: those who had not required both LA linear lesions to terminate AF (group A, 85 patients), and those who had (group B, 69 patients). There was no difference in clinical and echocardiographic characteristics between both groups except for a shorter duration of continuous AF in group A (9 vs.12 months, respectively) (P = 0.03). After 28 months of follow-up, the incidence of LA macro re-entrant AT necessitating linear ablation was higher in group A (76%) compared with group B (33%) (P = 0.002). When complete linear block could not be achieved during the index procedure, the incidence of subsequent roof (P = 0.008) or mitral isthmus (P = 0.010) dependent macro re-entrant AT was higher.


CONCLUSIONS
Although persistent AF can be terminated by catheter ablation without linear lesions, the majority will require linear lesions for macro re-entrant AT.
Knecht
Sébastien
S
Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux/Université Victor Segalen Bordeaux II, Bordeaux-Pessac, France. sebastien.knecht@chu-brugmann.be
Hocini
Mélèze
M
Wright
Matthew
M
Lellouche
Nicolas
N
O'Neill
Mark D
MD
Matsuo
Seiichiro
S
Nault
Isabelle
I
Chauhan
Vijay S
VS
Makati
Kevin J
KJ
Bevilacqua
Michela
M
Lim
Kang-Teng
KT
Sacher
Frederic
F
Deplagne
Antoine
A
Derval
Nicolas
N
Bordachar
Pierre
P
Jaïs
Pierre
P
Clémenty
Jacques
J
Haïssaguerre
Michel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*; D016896:Treatment Outcome