on December 2, 2008
Published online before print December 2, 2008, doi: 10.1161/CIRCEP.108.772392
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Original Article |
Chronic Atrial Fibrillation is a Biatrial Arrhythmia Data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach.
1 Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany;
2 Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
3 E-mail: rostock{at}uke.uni-hamburg.de
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 (RA) to the CAF process. Furthermore, the prognostic value of CAF termination remains unclear.
Methods and Results—Eighty-eight patients (61±10 y) 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 atrial (LA), coronary sinus (CS), and RA. Attempted procedural endpoint was termination of CAF. Consecutive arrhythmias occurring after AF termination were mapped and ablation was attempted. AF termination was achieved in 68 patients (77 %): in 37 (55%) patients it occurred in the LA, in 18 (26%) in the RA, and in 13 (19%) in the CS. 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 (SR, total 63), 8 in atrial tachycardia (AT) and 17 in AF. Another 11 patients underwent a second redo. After a mean follow-up of 20±4 months, 71 (81%) patients were in SR, 1 (1%) in AT and 16 (18%) 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 due to AT, at least 1 AT during redo was documented previously.
Conclusions—AF termination is a prognostic important endpoint of catheter ablation for CAF. Termination of AF was achieved in both atria and the CS, suggesting a biatrial substrate of CAF. Subsequent arrhythmias often recur during follow-up and therefore, should be targeted for ablation.
Key Words: ablation • catheter ablation • atrial fibrillation • atrial tachycardia • mechanisms
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