Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach.

TY - JOUR

T1 - Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach.

AU - Rostock, Thomas

AU - Steven, Daniel

AU - Hoffmann, Boris

AU - Servatius, Helge

AU - Drewitz, Imke

AU - Sydow, Karsten

AU - Müllerleile, Kai

AU - Ventura, Rodolfo

AU - Wegscheider, Karl

AU - Meinertz, Thomas

AU - Willems, Stephan

PY - 2008/12

Y1 - 2008/12

N2 - BACKGROUND: Termination of chronic atrial fibrillation (CAF) can be achieved by catheter ablation using a stepwise approach. However, there are limited data on the contribution of the right atrium to the CAF process. Furthermore, the prognostic value of CAF termination remains unclear. METHODS AND RESULTS: Eighty-eight patients (61+/-10 years of age) underwent de novo ablation of CAF in 2006 at our institution. The ablation procedure was performed sequentially in the following order: pulmonary vein isolation, defragmentation of the left atrium, coronary sinus, and right atrium. Attempted procedural end point was termination of CAF. Consecutive arrhythmias occurring after AF termination were mapped, and ablation was attempted. AF termination was achieved in 68 (77%) patients: in 37 (55%) patients it occurred in the left atrium, in 18 (26%) patients in the right atrium, and in 13 (19%) patients in the coronary sinus. In 54 patients, at least one redo was performed (total number of procedures: 154). After the first redo, another 30 patients were in sinus rhythm (total 63), 8 patients were in atrial tachycardia (AT), and 17 patients were in AF. Another 11 patients underwent a second redo. After a mean follow-up of 20+/-4 months, 71 (81%) patients were in sinus rhythm, 1 (1%) patient was in AT, and 16 (18%) patients were in AF. Patients with CAF termination had predominantly ATs as recurrent arrhythmias (83%), whereas those without mainly presented with recurrent CAF (85%). The overall success rate in patients with CAF termination was 95% compared with 5% of patients without CAF termination in 2 procedures (n=12). In almost all redo procedures attributable to AT, at least 1 AT during redo was documented previously. CONCLUSIONS: AF termination is a prognostic important end point of catheter ablation for CAF. Termination of AF was achieved in both atria and the coronary sinus, suggesting a biatrial substrate of CAF. Subsequent arrhythmias often recur during follow-up and, therefore, should be targeted for ablation.

AB - BACKGROUND: Termination of chronic atrial fibrillation (CAF) can be achieved by catheter ablation using a stepwise approach. However, there are limited data on the contribution of the right atrium to the CAF process. Furthermore, the prognostic value of CAF termination remains unclear. METHODS AND RESULTS: Eighty-eight patients (61+/-10 years of age) underwent de novo ablation of CAF in 2006 at our institution. The ablation procedure was performed sequentially in the following order: pulmonary vein isolation, defragmentation of the left atrium, coronary sinus, and right atrium. Attempted procedural end point was termination of CAF. Consecutive arrhythmias occurring after AF termination were mapped, and ablation was attempted. AF termination was achieved in 68 (77%) patients: in 37 (55%) patients it occurred in the left atrium, in 18 (26%) patients in the right atrium, and in 13 (19%) patients in the coronary sinus. In 54 patients, at least one redo was performed (total number of procedures: 154). After the first redo, another 30 patients were in sinus rhythm (total 63), 8 patients were in atrial tachycardia (AT), and 17 patients were in AF. Another 11 patients underwent a second redo. After a mean follow-up of 20+/-4 months, 71 (81%) patients were in sinus rhythm, 1 (1%) patient was in AT, and 16 (18%) patients were in AF. Patients with CAF termination had predominantly ATs as recurrent arrhythmias (83%), whereas those without mainly presented with recurrent CAF (85%). The overall success rate in patients with CAF termination was 95% compared with 5% of patients without CAF termination in 2 procedures (n=12). In almost all redo procedures attributable to AT, at least 1 AT during redo was documented previously. CONCLUSIONS: AF termination is a prognostic important end point of catheter ablation for CAF. Termination of AF was achieved in both atria and the coronary sinus, suggesting a biatrial substrate of CAF. Subsequent arrhythmias often recur during follow-up and, therefore, should be targeted for ablation.

KW - Humans

KW - Male

KW - Aged

KW - Female

KW - Middle Aged

KW - Treatment Outcome

KW - Time Factors

KW - Chronic Disease

KW - Atrial Fibrillation physiopathology

KW - Catheter Ablation adverse effects

KW - Coronary Sinus physiopathology

KW - Electrocardiography

KW - Heart Atria physiopathology

KW - Heart Rate

KW - Pulmonary Veins physiopathology

KW - Recurrence

KW - Reoperation

KW - Humans

KW - Male

KW - Aged

KW - Female

KW - Middle Aged

KW - Treatment Outcome

KW - Time Factors

KW - Chronic Disease

KW - Atrial Fibrillation physiopathology

KW - Catheter Ablation adverse effects

KW - Coronary Sinus physiopathology

KW - Electrocardiography

KW - Heart Atria physiopathology

KW - Heart Rate

KW - Pulmonary Veins physiopathology

KW - Recurrence

KW - Reoperation

U2 - 10.1161/CIRCEP.108.772392

DO - 10.1161/CIRCEP.108.772392

M3 - SCORING: Journal article

C2 - 19808429

VL - 1

SP - 344

EP - 353

JO - CIRC-ARRHYTHMIA ELEC

JF - CIRC-ARRHYTHMIA ELEC

SN - 1941-3149

IS - 5

M1 - 5

ER -