Catheter ablation of persistent atrial fibrillation: Circumferential pulmonary vein ablation: beneficial effect of an additional linear lesion at the roof of the left atrium on the long-term outcome; [Katheterablation von persistierendem Vorhofflimmern: Zirkumferenzielle Pulmonalvenenablation – günstiger Effekt einer zusätzlichen linearen Läsion am linksatrialen Vorhofdach auf das Langzeitergebnis]

被引:5
作者
Kettering K. [1 ]
Yim D.-H. [1 ]
Gramley F. [2 ]
机构
[1] Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, Frankfurt
[2] HPK Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg
关键词
Arrhythmia recurrences; Atrial fibrillation; Catheter ablation; Pulmonary veins;
D O I
10.1007/s00399-017-0519-x
中图分类号
学科分类号
摘要
Background: Circumferential pulmonary vein ablation is still the standard approach in patients with persistent atrial fibrillation. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods: A total of 125 patients with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). The long-term follow-up data was compared to 125 patients with similar clinical characteristics who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results: The ablation procedure could be performed as planned in all 250 patients. Three years after catheter ablation, the success rate was 72.0% (no arrhythmia recurrence in 90 out of 125 patients) in group A and 63.2% in group B (no arrhythmia recurrence in 79 out of 125 patients; P = 0.04). There were no major complications. Conclusions: Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable long-term results than circumferential pulmonary vein ablation alone. © 2017, Springer Medizin Verlag GmbH.
引用
收藏
页码:328 / 334
页数:6
相关论文
共 32 条
[1]  
Kettering K., Al-Ghobainy R., Wehrmann M., Vonthein R., Mewis C., Atrial linear lesions: feasibility using cryoablation, Pacing Clin Electrophysiol, 29, pp. 283-289, (2006)
[2]  
Oral H., Knight B.P., Ozaydin M., Chugh A., Lai S.W., Scharf C., Hassan S., Greenstein R., Han J.D., Pelosi F., Strickberger S.A., Morady F., Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights, Circulation, 106, 10, pp. 1256-1262, (2002)
[3]  
Haissaguerre M., Shah D.C., Jais P., Hocini M., Yamane T., Deisenhofer I., Garrigue S., Clementy J., Mapping-guided ablation of pulmonary veins to cure atrial fibrillation, Am J Cardiol, 86, pp. K9-K19, (2000)
[4]  
Gerstenfeld E.P., Guerra P., Sparks P.B., Hattori K., Lesh M.D., Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers, J Cardiovasc Electrophysiol, 12, 8, pp. 900-908, (2001)
[5]  
Marrouche N.F., Dresing T., Cole C., Bash D., Saad E., Balaban K., Pavia S.V., Schweikert R., Saliba W., Abdul-Karim A., Pisano E., Fanelli R., Tchou P., Natale A., Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies, J Am Coll Cardiol, 40, 3, pp. 464-474, (2002)
[6]  
Swartz J., Pellersels G., Silvers J., Patten L., Cervantez D., A catheter-based curative approach to atrial fibrillation in humans, Circulation, 90, 4, (1994)
[7]  
Haissaguerre M., Jais P., Shah D.C., Gencel L., Pradeau V., Garrigues S., Chouairi S., Hocini M., Le-Metayer P., Roudaut R., Clementy J., Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation, J Cardiovasc Electrophysiol, 7, 12, pp. 1132-1144, (1996)
[8]  
Ernst S., Schluter M., Ouyang F., Khanedani A., Cappato R., Hebe J., Volkmer M., Antz M., Kuck K.H., Modification of the substrate for maintenance of idiopathic human atrial fibrillation: efficacy of radiofrequency ablation using nonfluoroscopic catheter guidance, Circulation, 100, 20, pp. 2085-2092, (1999)
[9]  
Jais P., Hocini M., Hsu L.F., Sanders P., Scavee C., Weerasooriya R., Macle L., Raybaud F., Garrigue S., Shah D.C., Le-Metayer P., Clementy J., Haissaguerre M., Technique and results of linear ablation at the mitral isthmus, Circulation, 110, 19, pp. 2996-3002, (2004)
[10]  
Oral H., Chugh A., Lemola K., Cheung P., Hall B., Good E., Han J., Tamirisa K., Bogun F., Pelosi F., Morady F., Noninducibility of atrial fibrillation as an end point of left atrial circumferential ablation for paroxysmal atrial fibrillation: a randomized study, Circulation, 110, 18, pp. 2797-2801, (2004)