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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Trigger Activity More Than Three Years After Left Atrial Linear Ablation Without Pulmonary Vein Isolation in Patients With Atrial Fibrillation

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

Manuscript received November 16, 2004; revised manuscript received March 23, 2005, accepted March 29, 2005.

^_* Reprint requests and correspondence: Dr. Hildegard Tanner, University of Leipzig, Heart Center, Cardiology, Dept. of Electrophysiology, Struempellstrasse 39, D-04289 Leipzig, Germany (Email: hilditanner{at}pop.agri.ch).

OBJECTIVES: The aim of this study was to analyze trigger activity in the long-term follow-up after left atrial (LA) linear ablation.

BACKGROUND: Interventional strategies for curative treatment of atrial fibrillation (AF) are targeted at the triggers and/or the maintaining substrate. After substrate modification using nonisolating linear lesions, the activity of triggers is unknown.

METHODS: With the LA linear lesion concept, 129 patients were treated using intraoperative ablation with minimal invasive surgical techniques. Contiguous radiofrequency energy-induced lesion lines involving the mitral annulus and the orifices of the pulmonary veins without isolation were placed under direct vision.

RESULTS: After a mean follow-up of 3.6 ± 0.4 years, atrial ectopy, atrial runs, and reoccurrence of AF episodes were analyzed by digital 7-day electrocardiograms in 30 patients. Atrial ectopy was present in all patients. Atrial runs were present in 25 of 30 patients (83%), with a median number of 9 runs per patient/week (range 1 to 321) and a median duration of 1.2 s/run (range 0.7 to 25), without a significant difference in atrial ectopy and atrial runs between patients with former paroxysmal (n = 17) or persistent AF (n = 13). Overall, 87% of all patients were completely free from AF without antiarrhythmic drugs.

CONCLUSIONS: A detailed rhythm analysis late after specific LA linear lesion ablation shows that trigger activity remains relatively frequent but short and does not induce AF episodes in most patients. The long-term success rate of this concept is high in patients with paroxysmal or persistent AF.

Abbreviations and Acronyms   AF = atrial fibrillation   ECG = electrocardiogram   IRAAF = Intraoperative Radiofrequency Ablation of Atrial Fibrillation   LA = left atrium/atrial   MA = mitral annulus   PAC = premature atrial complex   PV = pulmonary vein   RF = radiofrequency

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