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J Am Coll Cardiol, 2003; 42:1271-1282, doi:10.1016/S0735-1097(03)00940-9
© 2003 by the American College of Cardiology Foundation
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ARTICLE

Catheter-induced linear lesions in theleft atrium in patients with atrial fibrillation

An electroanatomic study

Sabine Ernst, MD*, Feifan Ouyang, MD*, Felix Löber*, Matthias Antz, MD* and Karl-Heinz Kuck, MD*,*

* II. Med. Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany Drs. Ernst, Ouyang, Antz, and Kuck are trainers of the European Teaching Course of the CARTO system (Biosense Webster, Europe).

Manuscript received January 6, 2003; revised manuscript received April 9, 2003, accepted April 17, 2003.

* Reprint requests and correspondence: Dr. Karl-Heinz Kuck, AK St. Georg, 2. Med. Abteilung (Kardiologie), Lohmühlenstr. 5, 20099 Hamburg Germany.
sernst1708{at}aol.com

OBJECTIVES: In this study using radiofrequency current and the electroanatomic mapping system CARTO, four line designs were tested in 84 patients suffering from drug-refractory atrial fibrillation (AFib).

BACKGROUND: Prevention of AFib by trigger elimination within the pulmonary veins (PVs) has been recently reported, but the success may be lesser in patients with chronic AFib or large atria requiring linear lesion deployment.

METHODS: Type A encircled the ostia of all four PVs with a connection to the mitral annulus (MA). In type B, three lines connected anatomic barriers. Type C encircled both septal and lateral PVs with connections between PVs and to the MA. Type D encircled PVs only. In the initial 12 patients (type D/1), line validation was performed without, and in 23 patients (type D/2) with, an additional catheter inside the encircled PVs.

RESULTS: The ability to achieve completeness of all intended lines was 5% in type A, 21% in type B, 29% in C, 66% in type D/1, and 61% in type D/2. This resulted in stable sinus rhythm in 19% (4/21 patients) in type A, 32% (6/19 patients) in type B, 50% (7/14 patients) in type C, 58% (7/12 patients) in type D/1, and 65% (15/23 patients) in type D/2, respectively, over a mean follow-up of 620 ± 376 days. Besides thromboembolic events (one stroke and one transient ischemic attack), total occlusion of a PV was a major complication in one patient, and acute tamponade in two patients.

CONCLUSIONS: Complete lesions in the left atrium were difficult to achieve using conventional radiofrequency current technology, but were associated with sinus rhythm in 74% of patients during long-term follow-up, whereas incomplete lesions led mostly to recurrences of AFib or gap-related atrial tachycardia.

Abbreviations and Acronyms
  AFib = atrial fibrillation
  AT = atrial tachycardia
  CS = coronary sinus
  LA = left atrium/atrial
  LAA = left atrial appendage
  MA = mitral annulus
  PV = pulmonary vein
  RA = right atrium/atrial
  RFC = radiofrequency current
  SR = sinus rhythm




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