This Article Abstract 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 Ernst, S. Articles by Kuck, K.-H. Search for Related Content PubMed PubMed Citation Articles by Ernst, S. Articles by Kuck, K.-H.

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

An electroanatomic study

^* 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).

View larger version (113K): [in a new window]   Figure 1 Intended line designs: anterior posterior projections of a mesh graph of the electroanatomic mapping system CARTO of an LA with the pulmonary veins (PV) and the trans-septal sheath depicted as colored tubes. Ablation lines are depicted by multiple red dots. (A) A long encircling line around all four PV ostia (roof line) and a connection to the lateral mitral annulus (MA). (B) Roof line between the right and left superior PV ostium. The anterior line connects the middle of the roof line to the superior MA; the posterior line aims at the inferior MA with an intentional gap of approximately 3 cm. (C) Two encircling lines around the ostia of the superior and inferior PVs on both the septal and lateral sides. Additional connections between the PV segments (posterior line), the lateral PV segment, and the MA. (D) Encircling lines around the PVs on both sides without additional connection lines.

View larger version (241K): [in a new window]   Figure 2 Line validation (A) pulmonary artery (PA) projection of an activation map of the electroanatomic mapping system in the patient with a single persisting gap in the lateral aspect of the posterior line as depicted by the gradual change of colors at the site of the conduction gap. Complete lesions demonstrate double potential while constantly pacing from the coronary sinus (CS). (B) Comparison of the pre- and post-ablation activation map in a left anterior oblique projection for type B. The right-hand panel demonstrates the activation sequence along a multipolar catheter advanced in the distal CS while constantly pacing from the RA septal site. Please note the prolongation of the activation time after complete anterior line deployment in the distal CS electrodes. (C) Post-ablation activation map after pulmonary vein (PV) isolation during pacing from the CS catheter shown in a PA projection. Double potentials are marked with blue dots. (D) Comparison of voltage in the pre- and post-ablation maps in a posterior-anterior projection of the LA. The voltage is depicted according to the color spectrum shown in the right upper corner, ranging from low (<0.1 mV, red) to high-voltage (>1.5 mV, purple). (E) Left-hand panel depicts the multipolar catheter in the right upper PV (RUPV) during contrast injection through the second trans-septal sheath. The right panel demonstrates the loss of the PV spike potential (arrow) during radiofrequency current application. Surface lead II, as well as a bipolar electrogram from the 4-mm ablation catheter (Mp), four bipolar electrograms of the PV catheter (from distal to proximal), and from the proximal CS are shown. MA = mitral annulus.

View larger version (43K): [in a new window]   Figure 3 (A to E) (alternative to Table 2) Follow-up of treated patients using the respective ablation type. Patients are categorized with respect to results of line validation after the final ablation session. AA-TX = antiarrhythmic medication; AES = atrial extrasystoles; AFib = atrial fibrillation; AT = atrial tachycardia; i. AFib = intermittent atrial fibrillation; SR = sinus rhythm.