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CLINICAL RESEARCH

Left Atrial Ablation Versus Biatrial Ablation for Persistent and Permanent Atrial Fibrillation

A Prospective and Randomized Study

Leonardo Calò, MD, FESC^_*,_*, Filippo Lamberti, MD, Maria Luisa Loricchio, MD, Ermenegildo De Ruvo, MD^_*, Furio Colivicchi, MD, FESC, Leopoldo Bianconi, MD, Claudio Pandozi, MD, FESC and Massimo Santini, MD, FESC, FACC

^_* Division of Cardiology, Policlinico Casilino, ASL RM B, Rome, Italy
Division of Cardiology, Sant'Eugenio Hospital, Rome, Italy
Department of Cardiac Diseases, Sandro Pertini Hospital, Rome, Italy
Department of Cardiac Diseases, San Filippo Neri Hospital, Rome, Italy

Manuscript received November 22, 2005; revised manuscript received January 20, 2006, accepted February 7, 2006.

^_* Reprint requests and correspondence: Dr. Leonardo Calò, Division of Cardiology, Policlinico Casilino, Via Buonarroti, 16, 00047 Marino, Rome, Italy (Email: leonardo.calo{at}tin.it).

OBJECTIVES: The aim of this study was to compare—in patients with persistent and permanent atrial fibrillation (AF)—the efficacy and safety of left atrial ablation with that of a biatrial approach.

BACKGROUND: Left atrium-based catheter ablation of AF, although very effective in the paroxysmal form of the arrhythmia, has an insufficient efficacy in patients with persistent and permanent AF.

METHODS: Eighty highly symptomatic patients (age, 58.6 ± 8.9 years) with persistent (n = 43) and permanent AF (n = 37), refractory to antiarrhythmic drugs, were randomized to two different ablation approaches guided by electroanatomical mapping. A procedure including circumferential pulmonary vein, mitral isthmus, and cavotricuspid isthmus ablation was performed in 41 cases (left atrial ablation group). In the remaining 39 patients (biatrial ablation group), the aforementioned approach was integrated by the following lesions in the right atrium: intercaval posterior line, intercaval septal line, and electrical disconnection of the superior vena cava.

RESULTS: During follow-up (mean duration 14 ± 5 months), AF recurred in 39% of patients in the left atrial ablation group and in 15% of patients in the biatrial ablation group (p = 0.022). Multivariable Cox regression analysis showed that ablation technique was an independent predictor of AF recurrence during follow-up.

CONCLUSIONS: In patients with persistent and permanent AF, circumferential pulmonary vein ablation, combined with linear lesions in the right atrium, is feasible, safe, and has a significantly higher success rate than left atrial and cavotricuspid ablation alone.

Abbreviations and Acronyms   AF = atrial fibrillation   AFCL = atrial fibrillation cycle length   CI = confidence interval   CS = coronary sinus   PV = pulmonary vein

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