Published Online
on December 3, 2008

A more recent version of this article appeared on February 1, 2009

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Original Article

Left Atrial Posterior Wall Isolation Does Not Improve The Outcome of Circumferential Pulmonary Vein Ablation For Atrial Fibrillation: A Prospective Randomized Study

David Tamborero¹; Lluís Mont^1,3; Antonio Berruezo²; Maria Matiello¹; Begoña Benito¹; Marta Sitges¹; Barbara Vidal¹; Teresa M De Caralt¹; Rosario J Perea¹; Radu Vatasescu¹ and Josep Brugada¹

¹ Thorax Institute Hospital Clinic, University of Barcelona;
² Thorax Institute - Hospital Clinic, University of Barcelona

³ E-mail: lmont{at}clinic.ub.es

Background—Ablation of the pulmonary veins (PVs) for atrial fibrillation (AF) treatment is often combined with linear radiofrequency lesions along the left atrium (LA) to improve the success rate. The study was designed to assess the contribution of LA posterior wall isolation to the outcome of circumferential pulmonary vein ablation (CPVA).

Methods and Results—CPVA consisted of continuous radiofrequency lesions encircling both ipsilateral PVs plus an ablation line along the mitral isthmus. Patients were then randomized into two groups. In the first group, superior PVs were connected by linear lesions along the LA roof (CPVA-1 group). In the other group, the LA posterior wall was isolated by adding a second line connecting the inferior aspect of the two inferior PVs (CPVA-2 group). The study included 120 patients (53±11 years, 77% male, 60% paroxysmal AF, LA of 41.3±5.4 mm, 46% with hypertension and 22% with structural heart disease). After a single ablation procedure and a mean follow-up of 10±4 months, 24 (40%) patients of the CPVA-1 group had AF recurrences and 3 (5%) had new-onset LA flutter. In the CPVA-2 group, recurrences were due to AF episodes in 23 patients (38%) and LA flutter in 4 (7%). Freedom from arrhythmia recurrences was not statistically different in CPVA-1 group as compared to CPVA-2 (log rank p=0.943).

Conclusion—Isolation of the LA posterior wall did not increase the success rate of CPVA.

Key Words: arrhythmia • atrium • catheter ablation

Related Article

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective Randomized Study

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Circ Arrhythm Electrophysiol 2009 2: 35-40. [Abstract] [Full Text] [PDF]

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