Treatment of symptomatic intermitent atrial fibrillation with catheter ablation in the left atrium: Immediate and long-term results in 150 patients


Authors: M. Fiala 1,2;  J. Chovančík 1;  P. Heinc 2;  R. Neuwirth 1;  I. Nykl 1;  R. Nevřalová 1;  M. Branny 1
Authors‘ workplace: Kardiocentrum Nemocnice Podlesí, Třinec, přednosta prim MUDr. Marian Branny 1;  I. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Jan Lukl, CSc. 2
Published in: Vnitř Lék 2005; 51(9): 971-983
Category: Original Contributions

Overview

Catheter ablation has been establishing as a routine curative method of atrial fibrillation. Immediate and long-term results of catheter ablation employing method of pulmonary vein isolation using conventional or electroanatomic mapping in patients with intermitent atrial firillation are presented. Patients and methods: Ablation was performed in 150 patients (26 females), aged 52.4 plusmin 10.7 years, in 173 procedures. Results: During the initial ablation procedure in the first 110 patients, full pulmonary vein isolation was achieved in 358 (96%) of 372 target pulmonary veins. In 286 (77%) out of these 372 pulmonary veins, investigated angiografically before and after the isolation, mean narrowing from 12.6 plusmin 2.7 to 12.1 plusmin 2.8 mm was measured. Asymptomatic ostial narrowing, ranging between 25 až 50%, occurred in 16 (5.6%) of pulmonary veins. In the subsequent 40 patients, full isolation was achieved in all 160 pulmonary veins, and in none of them ostial stenosis and turbulent flow were found one month after the ablation during transesophageal echocardiographic examination. Twenty-two patients (15%) underwent a second and one patient a third ablation.Complication (embolic stroke resulting in hemianopsia) occurred in one (0.06%) out of 173 procedures. The mean follow-up period was 15.9 plusmin 10.3 months. First 110 patients had the folow-up period of 9-40 months and the following 40 patients had follow-up period of 1-6 month after ablation. Among the first 110 patients, 77%, 82%, 83%, 83%, 86%, resp. 89% patients were free of atrial fibrillation at 3rd, 6th, 9th, 12th and 18th month after ablation and the clinical benefit, ie. elimination of clinically significant atrial fibrillation was achieved in 85%, 89%, 91%, 93%, 92%, resp. 89% of the patients. In the last 40 patients, elimination of atrial fibrillation and clinical benefit at months 3 and 6 were achieved in 91% resp. 100% patients. Ablation was associated with a significant reduction of antiarhythmic and anticoagulation medication. Conclusion: Catheter ablation of intermitent atrial fibrillation in patients without major structural heart disease, based on full isolation of all pulmonary veins, is highly effective and relatively safe. Although technology and ablation strategies continuously evolve, ablation of atrial fibrillation can be currently considered a routine curative method.

Key words:
intermitent atrial fibrillation - catheter ablation - pulmonary vein isolation


Sources

1. Arentz T, von Rosenthal J, Blum T et al. Feasibility and safety of pulmonary vein isolation using a new mapping and navigation system in patients with refractory atrial fibrillation. Circulation 2003; 108: 2484-2490.

2. Cappato R, Negroni S, Pecora D et al. Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation 2003; 108: 1599-1604.

3. Haïssaguerre M, Jais P, Shah DC et al. Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 1996; 7: 1132-1144.

4. Haïssaguerre M, Jais P, Shah DC et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-666.

5. Haïssaguerre M, Shah DC, Jais P et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000; 101: 1409-1417.

6. Hwang C, Karagueuzian HS, Chen PS. Idiopathic paroxysmal atrial fibrillation induced by focal discharge mechanism in the left superior pulmonary vein: Possible roles of the ligament of Mashall. J Cardiovasc Electrophysiol 1999; 10: 636-648.

7. Jalife J, Berenfeld O, Mansour M. Mother rotors and fibrillatory conduction: A mechanism of atrial fibrillation. Cardiovasc Res 2002; 54: 204-216.

8. Macle L, Jaïs P, Weerasooriya R et al. Irrigated-tip catheter ablation of pulmonary veins for treatment of atrial fibrillation. J Cardiovasc Electrophysiol 2002; 13: 1067-1073.

9. Maloney JD, Milner L, Barold S et al. Two-staged biatrial linear and focal ablation to restore sinus rhythm in patients with refractory chronic atrial fibrillation. Pacing Clin Electrophysiol 1998; 21: 2527-2532.

10. Mandapati R, Skanes A, Chen J et al. Stable microreentrant sources as a mechanism of atrial fibrillation in the isolated sheep heart. Circulation 2000; 1: 194-199.

11. Marrouche NF, Dresing T, Cole C et al. Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation. J Am Coll Cardiol 2002; 40: 464-474.

12. Oral H, Scharf C, Chugh A et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003; 108: 2355-2360.

13. Pappone C, Oreto G, Lamberti F, et al. Catheter ablation of paroxysmal atrial fibrillation using 3D mapping system. Circulation 1999; 100: 1203-1208.

14. Pappone C, Oreto G, Rosanio S et al. Atrial electroanatomic remodelling after circumferential radiofrequency pulmonary vein ablation. Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001; 104: 2539-2544.

15. Pappone C, Rosanio S, Augello G et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation. J Am Coll Cardiol 2003; 42: 185-197.

16. Pappone C, Rosanio S, Oreto G et al. Circumferential radiofrequency ablation of pulmonary vein ostia. A new anatomic approach for curing atrial fibrillation. Circulation 2000; 102: 2619-2628.

17. Pappone C, Santinelli V, Manguso F et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation 2004; 109: 327-334.

18. Platonov PG, Mitrofanova LB, Chireikin LV et al. Morphology of interatrial conduction routes in patients with atrial fibrillation. Europace 2002; 4: 183-192.

19. Pürerfellner H, Cihal R, Aichinger J et al. Pulmonary vein stenosis by ostial irrigated-tip ablation: Incidence, time course, and prediction. J Cardiovasc Electrophysiol 2003; 14: 158-164.

20. Taylor GW, Neal GK, Zheng X et al. Pathological effects of extensive radiofrequency applications in the pulmonary veins in dogs. Circulation 2000; 101: 1736-1742.

Labels
Diabetology Endocrinology Internal medicine
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account