This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kottkamp, H. Articles by Hindricks, G. Search for Related Content PubMed PubMed Citation Articles by Kottkamp, H. Articles by Hindricks, G.

ATRIAL FIBRILLATION

Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions

Trigger elimination or substrate modification: Early or delayed cure?

University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany

Manuscript received January 29, 2004; revised manuscript received April 22, 2004, accepted April 27, 2004.

^* Reprint requests and correspondence: Prof. Dr. Hans Kottkamp, University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Struempellstrasse 39, D-04289 Leipzig, Germany (Email: Kotth{at}medizin.uni-leipzig.de).

OBJECTIVES: We sought to analyze the time course of atrial fibrillation (AF) episodes before and after circular plus linear left atrial ablation and the percentage of patients with complete freedom from AF after ablation by using serial seven-day electrocardiograms (ECGs).

BACKGROUND: The curative treatment of AF targets the pathophysiological corner stones of AF (i.e., the initiating triggers and/or the perpetuation of AF). The pathophysiological complexity of both may not result in an "all-or-nothing" response but may modify number and duration of AF episodes.

METHODS: In patients with highly symptomatic AF, circular plus linear ablation lesions were placed around the left and right pulmonary veins, between the two circles, and from the left circle to the mitral annulus using the electroanatomic mapping system. Repetitive continuous 7-day ECGs administered before and after catheter ablation were used for rhythm follow-up.

RESULTS: In 100 patients with paroxysmal (n = 80) and persistent (n = 20) AF, relative duration of time spent in AF significantly decreased over time (35 ± 37% before ablation, 26 ± 41% directly after ablation, and 10 ± 22% after 12 months). Freedom from AF stepwise increased in patients with paroxysmal AF and after 12 months measured at 88% or 74% depending on whether 24-h ECG or 7-day ECG was used. Complete pulmonary vein isolation was demonstrated in <20% of the circular lesions.

CONCLUSIONS: The results obtained in patients with AF treated with circular plus linear left atrial lesions strongly indicate that substrate modification is the main underlying pathophysiologic mechanism and that it results in a delayed cure instead of an immediate cure.

Abbreviations and Acronyms   AF = atrial fibrillation   ANOVA = analysis of variance   ECG = electrocardiogram   IRAAF = Intraoperative Radiofrequency Ablation of Atrial Fibrillation study   PV = pulmonary vein

This article has been cited by other articles:

				K. C. K. Wong, P. P. Sadarmin, J. De Bono, N. Qureshi, M. Jones, K. Rajappan, Y. Bashir, and T. R. Betts Local activation times at the high posterior wall of the left atrium during left atrial appendage pacing predict roof line block with high specificity and sensitivity Europace, September 1, 2011; 13(9): 1243 - 1249. [Abstract] [Full Text] [PDF]

				K. C. K. Wong, C. Lim, P. P. Sadarmin, M. Jones, N. Qureshi, J. De Bono, K. Rajappan, Y. Bashir, and T. R. Betts High incidence of acute sub-clinical circumflex artery 'injury' following mitral isthmus ablation Eur. Heart J., August 1, 2011; 32(15): 1881 - 1890. [Abstract] [Full Text] [PDF]

				J. R. Edgerton, C. Mahoney, M. J. Mack, K. Roper, and M. A. Herbert Long-term monitoring after surgical ablation for atrial fibrillation: How much is enough? J. Thorac. Cardiovasc. Surg., July 1, 2011; 142(1): 162 - 165. [Abstract] [Full Text] [PDF]

				C. Piorkowski, C. Eitel, S. Rolf, K. Bode, P. Sommer, T. Gaspar, S. Kircher, U. Wetzel, A. S. Parwani, L.-H. Boldt, et al. Steerable Versus Nonsteerable Sheath Technology in Atrial Fibrillation Ablation: A Prospective, Randomized Study Circ Arrhythm Electrophysiol, April 1, 2011; 4(2): 157 - 165. [Abstract] [Full Text] [PDF]

				C. Eitel, D. Husser, G. Hindricks, M. Fruhauf, S. Hilbert, A. Arya, T. Gaspar, U. Wetzel, A. Bollmann, and C. Piorkowski Performance of an implantable automatic atrial fibrillation detection device: impact of software adjustments and relevance of manual episode analysis Europace, April 1, 2011; 13(4): 480 - 485. [Abstract] [Full Text] [PDF]

				R. Cappato, H. Calkins, S.-A. Chen, W. Davies, Y. Iesaka, J. Kalman, Y.-H. Kim, G. Klein, A. Natale, D. Packer, et al. Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation Circ Arrhythm Electrophysiol, February 1, 2010; 3(1): 32 - 38. [Abstract] [Full Text] [PDF]

				A. Arya, G. Hindricks, P. Sommer, Y. Huo, A. Bollmann, T. Gaspar, K. Bode, D. Husser, H. Kottkamp, and C. Piorkowski Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients Europace, February 1, 2010; 12(2): 173 - 180. [Abstract] [Full Text] [PDF]

				C. Leclercq, L. Padeletti, R. Cihak, P. Ritter, G. Milasinovic, D. Gras, V. Paul, I.C. Van Gelder, C. Stellbrink, G. Rieger, et al. Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics Europace, January 1, 2010; 12(1): 71 - 77. [Abstract] [Full Text] [PDF]

				E. Anter and D. J. Callans Pharmacological and Electrical Conversion of Atrial Fibrillation to Sinus Rhythm Is Worth the Effort Circulation, October 6, 2009; 120(14): 1436 - 1443. [Full Text] [PDF]

				S. Lonnerholm, P. Blomstrom, L. Nilsson, and C. Blomstrom-Lundqvist A high quality of life is maintained late after Maze III surgery for atrial fibrillation Eur J Cardiothorac Surg, September 1, 2009; 36(3): 558 - 562. [Abstract] [Full Text] [PDF]

				T. Terasawa, E. M. Balk, M. Chung, A. C. Garlitski, A. A. Alsheikh-Ali, J. Lau, and S. Ip Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Ann Intern Med, August 4, 2009; 151(3): 191 - 202. [Abstract] [Full Text] [PDF]

				G. B. Forleo and C. Tondo Atrial fibrillation: cure or treat? Therapeutic Advances in Cardiovascular Disease, June 1, 2009; 3(3): 187 - 196. [Abstract] [PDF]

				M. D. O'Neill, M. Wright, S. Knecht, P. Jais, M. Hocini, Y. Takahashi, A. Jonsson, F. Sacher, S. Matsuo, K. T. Lim, et al. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint Eur. Heart J., May 1, 2009; 30(9): 1105 - 1112. [Abstract] [Full Text] [PDF]

				Task Force members, M. Brignole, P. Vardas, E. Hoffman, H. Huikuri, A. Moya, R. Ricci, N. Sulke, W. Wieling, EHRA Scientific Documents Committee, et al. Indications for the use of diagnostic implantable and external ECG loop recorders Europace, May 1, 2009; 11(5): 671 - 687. [Full Text] [PDF]

				H. Oral, A. Chugh, K. Yoshida, J. F. Sarrazin, M. Kuhne, T. Crawford, N. Chalfoun, D. Wells, W. Boonyapisit, S. Veerareddy, et al. A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation J. Am. Coll. Cardiol., March 3, 2009; 53(9): 782 - 789. [Abstract] [Full Text] [PDF]

				S. Knecht, M. Hocini, M. Wright, N. Lellouche, M. D. O'Neill, S. Matsuo, I. Nault, V. S. Chauhan, K. J. Makati, M. Bevilacqua, et al. Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation Eur. Heart J., October 1, 2008; 29(19): 2359 - 2366. [Abstract] [Full Text] [PDF]

				D. G. Katritsis Catheter Ablation of Atrial Fibrillation: For Whom and How? Angiology, August 1, 2008; 59(2_suppl): 103S - 106S. [Abstract] [PDF]

				T. Neumann, J. Vogt, B. Schumacher, A. Dorszewski, M. Kuniss, H. Neuser, K. Kurzidim, A. Berkowitsch, M. Koller, J. Heintze, et al. Circumferential Pulmonary Vein Isolation With the Cryoballoon Technique: Results From a Prospective 3-Center Study J. Am. Coll. Cardiol., July 22, 2008; 52(4): 273 - 278. [Abstract] [Full Text] [PDF]

				A. Noheria, A. Kumar, J. V. Wylie Jr, and M. E. Josephson Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation: A Systematic Review Arch Intern Med, March 24, 2008; 168(6): 581 - 586. [Abstract] [Full Text] [PDF]

				M. E.W. Hemels, J. H. Ruiter, G. P. Molhoek, N. J.G.M. Veeger, A. C.P. Wiesfeld, A. V. Ranchor, M. van Trigt, A. Pilmeyer, I. C. Van Gelder, and for The Features in AT500TM study; Chances for pat Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study Europace, March 1, 2008; 10(3): 306 - 313. [Abstract] [Full Text] [PDF]

				D. G. Katritsis and A. J. Camm Catheter ablation of atrial fibrillation: do we know what we are doing? Europace, November 1, 2007; 9(11): 1002 - 1005. [Full Text] [PDF]

				M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre Catheter Ablation for Atrial Fibrillation Circulation, September 25, 2007; 116(13): 1515 - 1523. [Full Text] [PDF]

				N. Dagres, C. Piorkowski, H. Kottkamp, D. Th. Kremastinos, and G. Hindricks Contemporary catheter ablation of arrhythmias in geriatric patients: patient characteristics, distribution of arrhythmias, and outcome Europace, July 1, 2007; 9(7): 477 - 480. [Abstract] [Full Text] [PDF]

				H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]

				L. Calo, F. Lamberti, M. L. Loricchio, E. De Ruvo, F. Colivicchi, L. Bianconi, C. Pandozi, and M. Santini Left Atrial Ablation Versus Biatrial Ablation for Persistent and Permanent Atrial Fibrillation: A Prospective and Randomized Study J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2504 - 2512. [Abstract] [Full Text] [PDF]

				J. H. Shuhaiber and J. T. Reston Reply to Mishra Eur J Cardiothorac Surg, March 1, 2006; 29(3): 425 - 426. [Full Text] [PDF]

				G. Stabile, E. Bertaglia, G. Senatore, A. De Simone, F. Zoppo, G. Donnici, P. Turco, P. Pascotto, M. Fazzari, and D. F. Vitale Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study) Eur. Heart J., January 2, 2006; 27(2): 216 - 221. [Abstract] [Full Text] [PDF]

				R. E. Accord, R.-J. van Suylen, T. J. van Brakel, and J. G. Maessen Post-Mortem Histologic Evaluation of Microwave Lesions After Epicardial Pulmonary Vein Isolation for Atrial Fibrillation Ann. Thorac. Surg., September 1, 2005; 80(3): 881 - 887. [Abstract] [Full Text] [PDF]

				A. Verma, F. Kilicaslan, E. Pisano, N. F. Marrouche, R. Fanelli, J. Brachmann, J. Geunther, D. Potenza, D. O. Martin, J. Cummings, et al. Response of Atrial Fibrillation to Pulmonary Vein Antrum Isolation Is Directly Related to Resumption and Delay of Pulmonary Vein Conduction Circulation, August 2, 2005; 112(5): 627 - 635. [Abstract] [Full Text] [PDF]

				H. Tanner, G. Hindricks, R. Kobza, A. Dorszewski, P. Schirdewahn, C. Piorkowski, J.-H. Gerds-Li, and H. Kottkamp Trigger Activity More Than Three Years After Left Atrial Linear Ablation Without Pulmonary Vein Isolation in Patients With Atrial Fibrillation J. Am. Coll. Cardiol., July 19, 2005; 46(2): 338 - 343. [Abstract] [Full Text] [PDF]

				G. Hindricks, C. Piorkowski, H. Tanner, R. Kobza, J.-H. Gerds-Li, C. Carbucicchio, and H. Kottkamp Perception of Atrial Fibrillation Before and After Radiofrequency Catheter Ablation: Relevance of Asymptomatic Arrhythmia Recurrence Circulation, July 19, 2005; 112(3): 307 - 313. [Abstract] [Full Text] [PDF]

				G. Senatore, G. Stabile, E. Bertaglia, G. Donnici, A. De Simone, F. Zoppo, P. Turco, P. Pascotto, and M. Fazzari Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation J. Am. Coll. Cardiol., March 15, 2005; 45(6): 873 - 876. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y.W. Lew, J. Narula, D. Sahn, et al. Highlights of the year in JACC 2004 J. Am. Coll. Cardiol., January 4, 2005; 45(1): 137 - 153. [Full Text] [PDF]