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 Thomas, S. P. Articles by Ross, D. L. Search for Related Content PubMed PubMed Citation Articles by Thomas, S. P. Articles by Ross, D. L.

CLINICAL STUDIES

Mechanism, localization and cure of atrial arrhythmias occurring after a new intraoperative endocardial radiofrequency ablation procedure for atrial fibrillation

Stuart P. Thomas, BMed, FRACP^a, Graham R. Nunn, MB, BS, FRACS^b, Ian A. Nicholson, MB, BS, FRACS^b, Arianwen Rees, BSc^a, Michael P. J. Daly, PhD, BEng, Richard B. Chard, MB, BS, FRACS^b and David L. Ross, MB, BS, FRACP^a

^a Department of Cardiology, Westmead Hospital, Westmead, NSW Australia2145
^b Department of Surgery, Westmead Hospital, Westmead, NSW Australia2145
Cooperative Research Centre for Cardiac Technology, Westmead Hospital, Westmead, NSW Australia2145

Manuscript received November 16, 1998; revised manuscript received August 24, 1999, accepted October 18, 1999.

Reprint requests and correspondence: Professor David L. Ross, Director, Department of Cardiology, Westmead Hospital, Westmead, NSW Australia 2145
davidr{at}westmed.wh.usyd.edu.au

OBJECTIVES

The purpose of this study was to test a new pattern of radiofrequency ablation for atrial fibrillation (AFib) intended to optimize atrial activation, and to demonstrate the usefulness of catheter techniques for mapping and ablation of postoperative atrial arrhythmias.

BACKGROUND

Linear radiofrequency lesions have been used to cure AFib, but the optimal pattern of lesions is unknown and postoperative tachyarrhythmias are common.

METHODS

A radial pattern of linear radiofrequency lesions (Star) was made using an endocardial open surgical approach in 25 patients. Postoperative arrhythmias were induced and characterized during electrophysiological studies in 15 patients.

RESULTS

The AFib was abolished in most patients (91%), but atrial flutter (AFlut) occurred in 96% of patients postoperatively. At postoperative electrophysiological studies, 37 flutter morphologies were studied in 15 patients (46% spontaneous, cycle length [CL] 223 ± 25 ms). Seven mechanisms (lesions discontinuity, n = 6; focal mechanism, n = 1) of AFlut were characterized in six patients. In these cases, flutter was abolished using further catheter radiofrequency ablation. In the remaining cases, flutter was usually localized to an area involving the interatrial septum, but no critical isthmus was identified for ablation. After 16 ± 10 months, 15 patients (65%) were asymptomatic with (n = 3) or without (n = 12) antiarrhythmic medications. Eight (35%) patients had persistent arrhythmias. Postoperative atrial electrical activation was near physiological.

CONCLUSIONS

The AFib may be abolished using a radial pattern of linear endocardial radiofrequency lesions, but postoperative AFlut is common even when lesions are made under optimal conditions. Endocardial mapping techniques can be used to characterize the flutter mechanisms, thus enabling subsequent successful catheter ablation.

Abbreviations and Acronyms   AFib = atrial fibrillation   AFlut = atrial flutter   CL = cycle length   TA = tricuspid annulus

This article has been cited by other articles:

				H. T. McElderry, D. C. McGiffin, V. J. Plumb, K. Nanthakumar, A. E. Epstein, T. Yamada, and G. N. Kay Proarrhythmic Aspects of Atrial Fibrillation Surgery: Mechanisms of Postoperative Macroreentrant Tachycardias Circulation, January 15, 2008; 117(2): 155 - 162. [Abstract] [Full Text] [PDF]

				A. C. Boyd, N. B. Schiller, D. L. Ross, and L. Thomas Segmental atrial contraction in patients restored to sinus rhythm after cardioversion for chronic atrial fibrillation: a colour Doppler tissue imaging study Eur J Echocardiogr, January 1, 2008; 9(1): 12 - 17. [Abstract] [Full Text] [PDF]

				J. P. Daubert Iatrogenic Left Atrial Tachycardias: Where Are We? J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1788 - 1790. [Full Text] [PDF]

				P. Sanders, M. Hocini, P. Jais, L.-F. Hsu, Y. Takahashi, M. Rotter, C. Scavee, J.-L. Pasquie, F. Sacher, T. Rostock, et al. Characterization of Focal Atrial Tachycardia Using High-Density Mapping J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2088 - 2099. [Abstract] [Full Text] [PDF]

				A. Chugh, H. Oral, E. Good, J. Han, K. Tamirisa, K. Lemola, D. Elmouchi, D. Tschopp, S. Reich, P. Igic, et al. Catheter Ablation of Atypical Atrial Flutter and Atrial Tachycardia Within the Coronary Sinus After Left Atrial Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., July 5, 2005; 46(1): 83 - 91. [Abstract] [Full Text] [PDF]

				E. Bugge, I. A. Nicholson, and S. P. Thomas Comparison of bipolar and unipolar radiofrequency ablation in an in vivo experimental model Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 76 - 80. [Abstract] [Full Text] [PDF]

				M. Hocini, P. Sanders, P. Jais, L.-F. Hsu, R. Weerasoriya, C. Scavee, Y. Takahashi, M. Rotter, F. Raybaud, L. Macle, et al. Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins Eur. Heart J., April 1, 2005; 26(7): 696 - 704. [Abstract] [Full Text] [PDF]

				G. Golovchiner, A. Mazur, A. Kogan, B. Strasberg, Y. Shapira, M. Fridman, J. Kuzniec, B. A. Vidne, and E. Raanani Atrial Flutter After Surgical Radiofrequency Ablation of the Left Atrium for Atrial Fibrillation Ann. Thorac. Surg., January 1, 2005; 79(1): 108 - 112. [Abstract] [Full Text] [PDF]

				L. Thomas, A. Boyd, S. P. Thomas, N. B. Schiller, and D. L. Ross Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation Eur. Heart J., November 1, 2003; 24(21): 1942 - 1951. [Abstract] [Full Text] [PDF]

				Committee Members, C. Blomstrom-Lundqvist, M. M. Scheinman, E. M. Aliot, J. S. Alpert, H. Calkins, A. J. Camm, W. B. Campbell, D. E. Haines, K. H. Kuck, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias --executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) Developed in Collaboration with NASPE-Heart Rhythm Society J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1493 - 1531. [Full Text] [PDF]

				C. Blomstrom-Lundqvist, M. M. Scheinman, E. M. Aliot, J. S. Alpert, H. Calkins, A. J. Camm, W. B. Campbell, D. E. Haines, K. H. Kuck, B. B. Lerman, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias*--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias) Circulation, October 14, 2003; 108(15): 1871 - 1909. [Full Text] [PDF]

				Committee Members, C. Blomstrom-Lundqvist, M. M Scheinman, E. M Aliot, J. S Alpert, H. Calkins, A.J. Camm, W.B. Campbell, D. E Haines, K. H Kuck, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: A Report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines(Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias)Developed in collaboration with NASPE-Heart Rhythm Society Eur. Heart J., October 2, 2003; 24(20): 1857 - 1897. [Full Text] [PDF]

				S. P. Thomas, D. J.R. Guy, A. C. Boyd, V. E. Eipper, D. L. Ross, and R. B. Chard Comparison of epicardial and endocardial linear ablation using handheld probes Ann. Thorac. Surg., February 1, 2003; 75(2): 543 - 548. [Abstract] [Full Text] [PDF]

				F. Hornero, J. A. Montero, S. Canovas, and M. Bueno Biatrial radiofrequency ablation for atrial fibrillation: epicardial and endocardial surgical approach Interactive CardioVascular and Thoracic Surgery, December 1, 2002; 1(2): 72 - 77. [Abstract] [Full Text] [PDF]

				S. P. Thomas, I. A. Nicholson, G. R. Nunn, and D. L. Ross Radiofrequency lesions produced by handheld temperature controlled probes for use in atrial fibrillation surgery Eur. J. Cardiothorac. Surg., December 1, 2001; 20(6): 1188 - 1193. [Abstract] [Full Text] [PDF]

				M. R. Williams, J. R. Stewart, S. F. Bolling, S. Freeman, J. T. Anderson, M. Argenziano, C. R. Smith, and M. C. Oz Surgical treatment of atrial fibrillation using radiofrequency energy Ann. Thorac. Surg., June 1, 2001; 71(6): 1939 - 1944. [Abstract] [Full Text] [PDF]

				M. M. Scheinman and F. Morady Nonpharmacological Approaches to Atrial Fibrillation Circulation, April 24, 2001; 103(16): 2120 - 2125. [Abstract] [Full Text] [PDF]