title: Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach.
abstract: BACKGROUND
  Termination of chronic atrial fibrillation (CAF) can be achieved by catheter ablation using a stepwise approach. However, there are limited data on the contribution of the right atrium to the CAF process. Furthermore, the prognostic value of CAF termination remains unclear.
  
  
  RESULTS
  Eighty-eight patients (61+/-10 years of age) underwent de novo ablation of CAF in 2006 at our institution. The ablation procedure was performed sequentially in the following order: pulmonary vein isolation, defragmentation of the left atrium, coronary sinus, and right atrium. Attempted procedural end point was termination of CAF. Consecutive arrhythmias occurring after AF termination were mapped, and ablation was attempted. AF termination was achieved in 68 (77%) patients: in 37 (55%) patients it occurred in the left atrium, in 18 (26%) patients in the right atrium, and in 13 (19%) patients in the coronary sinus. In 54 patients, at least one redo was performed (total number of procedures: 154). After the first redo, another 30 patients were in sinus rhythm (total 63), 8 patients were in atrial tachycardia (AT), and 17 patients were in AF. Another 11 patients underwent a second redo. After a mean follow-up of 20+/-4 months, 71 (81%) patients were in sinus rhythm, 1 (1%) patient was in AT, and 16 (18%) patients were in AF. Patients with CAF termination had predominantly ATs as recurrent arrhythmias (83%), whereas those without mainly presented with recurrent CAF (85%). The overall success rate in patients with CAF termination was 95% compared with 5% of patients without CAF termination in 2 procedures (n=12). In almost all redo procedures attributable to AT, at least 1 AT during redo was documented previously.
  
  
  CONCLUSIONS
  AF termination is a prognostic important end point of catheter ablation for CAF. Termination of AF was achieved in both atria and the coronary sinus, suggesting a biatrial substrate of CAF. Subsequent arrhythmias often recur during follow-up and, therefore, should be targeted for ablation.
authors.affiliation: Departments of Cardiology, and Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany. rostock@uke.uni-hamburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Boris
authors.initials: B
authors.lastname: Hoffmann
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.forename: Imke
authors.initials: I
authors.lastname: Drewitz
authors.forename: Karsten
authors.initials: K
authors.lastname: Sydow
authors.forename: Kai
authors.initials: K
authors.lastname: Müllerleile
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Ventura
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D054326:Coronary Sinus / Q000503:physiopathology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome