Published online before print April 30, 2008, doi: 10.1161/CIRCEP.108.769752
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Original Articles |
Atrial Arrhythmias After Single-Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation
Mechanisms and Management
From the University of Sydney (T.W.L., D.L.R., S.P.T.); Department of Cardiology (T.W.L., C.H.K., V.A.S., D.L.R., S.P.T.), Westmead Hospital; and Westmead Private Hospital (R.M.), Sydney, Australia.
Correspondence to Stuart P. Thomas, PhD, FRACP, Department of Cardiology, Westmead Hospital, Cnr Hawkesbury and Darcy Rds, Westmead, NSW 2145, Australia. E-mail stuartpt{at}yahoo.com
Received January 29, 2008; accepted April 18, 2008.
Background— Single-ring isolation of the posterior left atrium is feasible, but the incidence and mechanisms of postprocedural arrhythmias have not been described in detail.
Methods and Results— The first 100 consecutive patients (58.8±11.2 years old, 80 male) who underwent single-ring isolation for atrial fibrillation (66 intermittent, 18 persistent, 16 long-standing persistent) were followed up for 9.1±4.5 months. Recurrences were diagnosed by clinical symptoms and Holter monitoring. Patients with recurrences of sustained atrial arrhythmia >3 months after the procedure were offered a repeat procedure and were studied to determine the mechanisms of recurrence. Forty-six patients (46%) experienced sustained postprocedural atrial arrhythmias (35 had atrial fibrillation, and 34 had atrial flutter). Of these, 34 required a second procedure 7.0±3.1 months after their initial procedure. Reconnection of the posterior left atrium was seen in all patients with atrial fibrillation. Atrial flutter was most commonly due to mitral isthmus-dependent macroreentry (n=8, cycle length 368±116 ms) or macroreentry through 2 gaps in the ring of lesions (n=6, cycle length 328±115 ms). Posterior left atrium reisolation was achieved at the second procedure in all patients. Atrial flutter was successfully ablated and rendered noninducible in all patients. Six months after their last procedure, the Kaplan-Meier estimate of freedom from recurrence for all 100 patients was 81±5%.
Conclusions— Atrial fibrillation and atrial flutter recurrence is common after single-ring isolation. Reconnection of the posterior left atrium and macroreentry are the common mechanisms. Repeat ablation results in satisfactory short-term outcomes.
Key Words: atrium • fibrillation • catheter ablation • atrial flutter
CLINICAL PERSPECTIVE
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