Trigger Activity More Than Three Years After Left Atrial Linear Ablation Without Pulmonary Vein Isolation in Patients With Atrial Fibrillation
Hildegard Tanner, MD*,
Gerhard Hindricks, MD,
Richard Kobza, MD,
Anja Dorszewski, MD,
Petra Schirdewahn, MD,
Christopher Piorkowski, MD,
Jin-Hong Gerds-Li, MD and
Hans Kottkamp, MD
University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany
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Figure 1 Drawing of the left atrium (LA) in a postero-anterior view with the radiofrequency energy-induced left atrial linear lesions (dense black lines) for treatment of atrial fibrillation. The first line extended from the mitral annulus (MA) to the left lower pulmonary vein (LLPV). The second line connected the LLPV and the left upper pulmonary vein (LUPV) orifices. From there, a third line coupled the left and the right pulmonary veins. Then the right upper pulmonary vein (RUPV) and right lower pulmonary vein (RLPV) orifices were connected. Care was taken to advance the tip of the ablation probe only a few millimeters inside the funnel-shaped parts of the pulmonary veins. Finally, the line at the LA roof was connected to the surgical incision to prevent "incisional re-entry." The dotted line indicates the LA incision. IVC = inferior vena cava; LAA = left atrial appendage; SVC = superior vena cava.
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Figure 2 Typical examples of electrocardiogram recordings of rare and frequent premature atrial complexes (A and B), short and long atrial runs (C and D), and atrial fibrillation (E) in five different patients.
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Figure 3 Presence of atrial (AT) runs, frequent (>100) premature atrial complexes (PAC), and PAC in all patients, and in those with former paroxysmal (n = 17) and persistent (n = 13) atrial fibrillation (AF). Ruled bars = all patients; dotted bars = paroxysmal AF; black bars = persistent AF.
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Figure 4 Freedom from atrial fibrillation (AF) in all patients and in those with former paroxysmal (n = 17) and persistent (n = 13) AF after 3.6 ± 0.4 years.
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Figure 5 Freedom from atrial fibrillation (AF) after the procedure and after 6 months and 1, 2, and 3 years, respectively. Follow-up was done by continuous monitoring during the first week after ablation, conventional 24-h electrocardiogram (ECG) after 6 months and 1 and 2 years, and 7-day ECG after 3 years.
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