This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.05.069v3 46/6/1060    most recent 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 Web of Science 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 Web of Science (45) Citing Articles via Google Scholar Google Scholar Articles by Lemola, K. Articles by Morady, F. Search for Related Content PubMed PubMed Citation Articles by Lemola, K. Articles by Morady, F.

CLINICAL RESEARCH: CARDIAC RHYTHM DISORDERS

Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation

Division of Cardiology, University of Michigan, Ann Arbor, Michigan.

Manuscript received September 21, 2004; revised manuscript received May 8, 2005, accepted May 13, 2005.

^_* Reprint requests and correspondence: Dr. Hakan Oral, Cardiology, TC B1 140D, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0311. (Email: oralh{at}umich.edu).

OBJECTIVES: We sought to determine whether elimination of pulmonary vein (PV) arrhythmogenicity is necessary for the efficacy of left atrial circumferential ablation (LACA) for atrial fibrillation (AF).

BACKGROUND: The PVs often provide triggers or drivers of AF. It has been shown that LACA is more effective than PV isolation in eliminating paroxysmal AF. However, it is not clear whether complete PV isolation is necessary for the efficacy of LACA.

METHODS: In 60 consecutive patients with paroxysmal (n = 39) or chronic (n = 21) AF (mean age 53 ± 12 years), LACA to encircle the left- and right-sided PVs, with additional lines in the posterior left atrium and along the mitral isthmus, was performed under the guidance of an electroanatomic navigation system. The PVs were mapped with a decapolar ring catheter before and after LACA. If PV isolation was incomplete, no attempts at complete isolation were made.

RESULTS: After LACA, there was incomplete electrical isolation of one or more PVs in 48 (80%) of the 60 patients. The prevalence of PV tachycardias was 82% before and 8% after LACA (p < 0.001). At 11 ± 1 months of follow-up, 10 (83%) of the 12 patients with complete and 39 (81%) of 48 patients with incomplete PV isolation were free from recurrent AF without antiarrhythmic drug therapy (p = 1.0). A successful outcome was not related to the number of completely isolated PVs per patient (p = 0.6).

CONCLUSIONS: Left atrial circumferential ablation modifies the arrhythmogenic substrate within the PVs. Complete electrical isolation of the PVs is not a requirement for a successful outcome after LACA.

Abbreviations and Acronyms   AF = atrial fibrillation   CS = coronary sinus   LA = left atrium/atrial   LACA = left atrial circumferential ablation   PV = pulmonary vein   RF = radiofrequency

This article has been cited by other articles:

				D. Shah Electrophysiological evaluation of pulmonary vein isolation Europace, November 1, 2009; 11(11): 1423 - 1433. [Abstract] [Full Text] [PDF]

				J Pontoppidan, J C Nielsen, S H Poulsen, H K Jensen, H Walfridsson, A K Pedersen, and P S Hansen Prophylactic cavotricuspid isthmus block during atrial fibrillation ablation in patients without atrial flutter: a randomised controlled trial Heart, June 15, 2009; 95(12): 994 - 999. [Abstract] [Full Text] [PDF]

				G. B. Chierchia, C. de Asmundis, S.-A. Muller-Burri, A. Sarkozy, L. Capulzini, G. Paparella, S. Chierchia, M. Roos, and P. Brugada Early recovery of pulmonary vein conduction after cryoballoon ablation for paroxysmal atrial fibrillation: a prospective study Europace, April 1, 2009; 11(4): 445 - 449. [Abstract] [Full Text] [PDF]

				D. Schwartzman and J. L. Williams Electroanatomic properties of pulmonary vein antral regions enclosed by encircling ablation lesions Europace, April 1, 2009; 11(4): 435 - 444. [Abstract] [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]

				D. Tamborero, L. Mont, A. Berruezo, M. Matiello, B. Benito, M. Sitges, B. Vidal, T. M. de Caralt, R. J. Perea, R. Vatasescu, et al. Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective Randomized Study Circ Arrhythm Electrophysiol, February 1, 2009; 2(1): 35 - 40. [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]

				D. Katritsis, M. A. Wood, E. Giazitzoglou, R. K. Shepard, G. Kourlaba, and K. A. Ellenbogen Long-term follow-up after radiofrequency catheter ablation for atrial fibrillation Europace, April 1, 2008; 10(4): 419 - 424. [Abstract] [Full Text] [PDF]

				X.-h. Wang, H.-f. Shi, Y.-m. Sun, J.-n. Gu, L. Zhou, and X. Liu Circumferential pulmonary vein isolation: the role of key target sites Europace, February 1, 2008; 10(2): 197 - 204. [Abstract] [Full Text] [PDF]

				K. Lemola, D. Chartier, Y.-H. Yeh, M. Dubuc, R. Cartier, A. Armour, M. Ting, M. Sakabe, A. Shiroshita-Takeshita, P. Comtois, et al. Pulmonary Vein Region Ablation in Experimental Vagal Atrial Fibrillation: Role of Pulmonary Veins Versus Autonomic Ganglia Circulation, January 29, 2008; 117(4): 470 - 477. [Abstract] [Full Text] [PDF]

				C. Pratola, E. Baldo, P. Notarstefano, T. Toselli, and R. Ferrari Radiofrequency Ablation of Atrial Fibrillation: Is the Persistence of All Intraprocedural Targets Necessary for Long-Term Maintenance of Sinus Rhythm? Circulation, January 15, 2008; 117(2): 136 - 143. [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]

				S. Chae, H. Oral, E. Good, S. Dey, A. Wimmer, T. Crawford, D. Wells, J.-F. Sarrazin, N. Chalfoun, M. Kuhne, et al. Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation: Mechanistic Insights, Results of Catheter Ablation, and Risk Factors for Recurrence J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1781 - 1787. [Abstract] [Full Text] [PDF]

				X.-h. Wang, X. Liu, Y.-m. Sun, J.-n. Gu, H.-f. Shi, L. Zhou, and W. Hu Early identification and treatment of PV re-connections: role of observation time and impact on clinical results of atrial fibrillation ablation Europace, July 1, 2007; 9(7): 481 - 486. [Abstract] [Full Text] [PDF]

				A. M. Gillinov, S. Bhavani, E. H. Blackstone, J. Rajeswaran, L. G. Svensson, J. L. Navia, B.G. Pettersson, J. F. Sabik III, N. G. Smedira, T. Mihaljevic, et al. Surgery for Permanent Atrial Fibrillation: Impact of Patient Factors and Lesion Set Ann. Thorac. Surg., August 1, 2006; 82(2): 502 - 514. [Abstract] [Full Text] [PDF]

				H. Oral, A. Chugh, E. Good, S. Sankaran, S. S. Reich, P. Igic, D. Elmouchi, D. Tschopp, T. Crawford, S. Dey, et al. A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation Circulation, April 18, 2006; 113(15): 1824 - 1831. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas Highlights of the Year in JACC 2005 J. Am. Coll. Cardiol., January 3, 2006; 47(1): 184 - 202. [Full Text] [PDF]