CLINICAL RESEARCH
Effects of Stepwise Ablation of Chronic Atrial Fibrillation on Atrial Electrical and Mechanical Properties
Yoshihide Takahashi, MD*,
Mark D. O'Neill, MB, BCh, DPhil,
Méléze Hocini, MD,
Patricia Reant, MD,
Anders Jonsson, MD,
Pierre Jaïs, MD,
Prashanthan Sanders, MBBS, PhD,
Thomas Rostock, MD,
Martin Rotter, MD,
Frédéric Sacher, MD,
Stephane Laffite, MD, PhD,
Raymond Roudaut, MD,
Jacques Clémenty, MD and
Michel Haïssaguerre, MD
Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux 2, Bordeaux, France
Manuscript received September 11, 2006;
revised manuscript received October 30, 2006,
accepted November 19, 2006.
* Reprint requests and correspondence: Dr. Yoshihide Takahashi, Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. (Email: yoshihide_takahashi{at}oboe.ocn.ne.jp).
Objectives: This study sought to evaluate the effects of stepwise catheter ablation of chronic atrial fibrillation (AF) on atrial electrical and mechanical properties.
Background: Although stepwise catheter ablation of chronic AF is associated with acute arrhythmia termination and a favorable clinical outcome, atrial tissue damage following the procedure has not been evaluated.
Methods: Forty patients who had previously undergone catheter ablation of chronic AF were studied. In the index procedure, termination of AF was achieved by catheter ablation alone in 36 of 40 patients (90%). Electroanatomical mapping was performed in sinus rhythm  1 month after the index procedure, during which the surface area of scar (bipolar voltage of <0.05 mV), low-voltage tissue (<0.5 mV), and atrial propagation were evaluated. Left atrial (LA) mechanical function was assessed by transthoracic echocardiography.
Results: Electroanatomical mapping showed areas of scar and low-voltage accounting for 31% ± 12% and 32% ± 17% of the total LA surface area respectively, with the ablated pulmonary vein region accounting for 20% ± 4% of the LA surface area. The area of scar outside the pulmonary vein region represented 14% ± 12% of the LA surface area using the initial randomized ablation strategy, and 6% ± 8% (p = 0.02) using a specific ablation strategy. Atrial conduction was diversely affected by ablation with a wide range of LA conduction times observed (range 100 to 360 ms). The LA contraction was shown in all patients by the presence of late diastolic mitral flow (37 ± 15 cm/s) and a mean LA active emptying fraction of 18 ± 11%. At 9 ± 5 months of follow-up, 39 patients (98%) were in sinus rhythm.
Conclusions: Stepwise ablation achieving sinus rhythm in patients with chronic AF has a significant impact on LA electrical activity but is associated with recovery of LA function.
|
Abbreviations and Acronyms
| | AF = atrial fibrillation | | AT = atrial tachycardia | | CS = coronary sinus | | LA = left atrium | | LAA = left atrial appendage | | LV = left ventricle | | PV = pulmonary vein | | RA = right atrium | | SVC = superior vena cava |
|
This article has been cited by other articles:
|
|
|
|
 
T. Rostock, D. Steven, B. Hoffmann, H. Servatius, I. Drewitz, K. Sydow, K. Mullerleile, R. Ventura, K. Wegscheider, T. Meinertz, et al.
Chronic Atrial Fibrillation Is a Biatrial Arrhythmia: Data from Catheter Ablation of Chronic Atrial Fibrillation Aiming Arrhythmia Termination Using a Sequential Ablation Approach
Circ Arrhythmia Electrophysiol,
December 1, 2008;
1(5):
344 - 353.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Knecht, I. Nault, M. Wright, S. Matsuo, N. Lellouche, P. E. Somasundaram, M. D. O'Neill, K.-T. Lim, F. Sacher, A. Deplagne, et al.
Imaging in catheter ablation for atrial fibrillation: enhancing the clinician's view
Europace,
November 1, 2008;
10(suppl_3):
iii2 - iii7.
[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]
|
|
|
|
|
|
|
Y. Takahashi, M. D. O'Neill, M. Hocini, R. Dubois, S. Matsuo, S. Knecht, S. Mahapatra, K.-T. Lim, P. Jais, A. Jonsson, et al.
Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation.
J. Am. Coll. Cardiol.,
March 11, 2008;
51(10):
1003 - 1010.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Arrantes, F. Gaita, K.-t. Lim, M. Scaglione, P. Jais, M. Hocini, S. Matsuo, S. Knecht, and M. Haissaguerre
Atrial fibrillation ablation: evolution of the curative approach
Eur. Heart J. Suppl.,
December 1, 2007;
9(suppl_I):
I129 - I135.
[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]
|
|
|
|
