Published Online
on April 30, 2008

A more recent version of this article appeared on June 1, 2008

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Original Article

Atrial Arrhythmias after Single Ring Isolation of the Posterior Left Atrium and Pulmonary Veins for Atrial Fibrillation: Mechanisms and Management

Toon Wei Lim¹, Choon Hiang Koay¹, Rebecca McCall², Valerie A See¹, David L Ross¹ and Stuart P Thomas^1,3

¹ Westmead Hospital;
² Westmead Private Hospital

Correspondence: ³ E-mail: stuartpt{at}yahoo.com

Background—Single ring isolation of the posterior left atrium (PLA) is feasible but the incidence and mechanisms of post-procedural 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 (AF; 66 intermittent, 18 persistent, 16 longstanding persistent) were followed for 9.1 ± 4.5 months. Recurrences were diagnosed by clinical symptoms and Holter Monitoring. Patients with recurrences of sustained atrial arrhythmia more than 3 months after the procedure were offered a repeat procedure and were studied to determine the mechanisms of recurrence. Forty-six (46%) patients experienced sustained post-procedural atrial arrhythmias (35 had AF and 34 had atrial flutter (AFL)). Of these, 34 required a second procedure 7.0 ± 3.1 months after their initial procedure. Reconnection of the PLA was seen in all patients with AF. AFL was most commonly due to mitral isthmus dependent macroreentry (n=8, cycle length 368 ± 116 ms) or macroreentry through two gaps in the ring of lesions (n=6, cycle length 328 ± 115 ms). PLA re-isolation was achieved at the second procedure in all patients. AFL was successfully ablated and rendered non-inducible 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—AF and AFL recurrence is common after single ring isolation. Reconnection of the PLA and macroreentry are the common mechanisms. Repeat ablation results in satisfactory short term outcomes.

Key Words: atrial flutter • atrium • catheter ablation • fibrillation

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