Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions
Trigger elimination or substrate modification: Early or delayed cure?
Hans Kottkamp, MD*,
Hildegard Tanner, MD,
Richard Kobza, MD,
Petra Schirdewahn, MD,
Anja Dorszewski, MD,
Jin-Hong Gerds-Li, MD,
Corrado Carbucicchio, MD,
Christopher Piorkowski, MD and
Gerhard Hindricks, MD
University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany
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Figure 1 (A) Schematic drawing of the left atrium, including the pulmonary veins (PV), the mitral annulus (MA), and the radiofrequency energy-induced lesion lines. A circumferential lesion was placed around the left and right PVs >5 mm from the orifices. In addition, two linear lesions were placed, one connecting the circular lesions and one connecting the left circular lesion with the MA (so-called left atrial isthmus). (B) Posteroanterior view of an electroanatomic reconstruction of the left atrium, including the PV. Dark red dots represent ablation lines as described above. LAA = left atrial appendage; LLPV = left lower PV; LUPV = left upper PV; RLPV = right lower PV; RMPV = right middle PV; RUPV = right upper PV.
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Figure 2 Example of 7-day electrocardiogram recordings in a patient who underwent placement of circular plus linear left atrial lesions for treatment of atrial fibrillation (AF) before ablation as well as 3 and 6 months after ablation. In this case, the paroxysms of AF were easily recognized on the seven-day frequency profile by the abrupt occurrence of tachyarrhythmia. HR = heart rate.
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Figure 3 Relative duration of atrial fibrillation (AF) in % of total recording during 7-day electrocardiogram (ECG) recording before ablation, directly after ablation, and 3, 6, and 12 months after placement of circular plus linear left atrial lesions.
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Figure 4 Freedom from atrial fibrillation (AF) with comparison of classic 24-h Holter-electrocardiogram (ECG) versus 7-day ECG and percentage of patients on antiarrhythmic drugs (AAD) after placement of circular plus linear left atrial lesions. Open bars = 24-h ECG; closed bars = 7-day ECG.
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Figure 5 Time course of number of atrial fibrillation (AF) episodes in patients with recurrent AF episodes after placement of circular plus linear left atrial lesions. ECG = electrocardiogram.
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Figure 6 Time course of duration of individual atrial fibrillation (AF) episodes in patients with recurrent AF episodes after placement of circular plus linear left atrial lesions. ECG = electrocardiogram.
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Figure 7 Time course of the relative distribution of length of individual atrial fibrillation (AF) episodes in patients with recurrent AF episodes after placement of circular plus linear left atrial lesions. Closed bars = >24 h; hatched bars = >2 to 24 h; open bars = 30 s to 2 h. ECG = electrocardiogram.
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