Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach.
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Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach. / Rostock, Thomas; Steven, Daniel; Hoffmann, Boris; Servatius, Helge; Drewitz, Imke; Sydow, Karsten; Müllerleile, Kai; Ventura, Rodolfo; Wegscheider, Karl; Meinertz, Thomas; Willems, Stephan.
In: CIRC-ARRHYTHMIA ELEC, Vol. 1, No. 5, 5, 12.2008, p. 344-353.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -