Modification of the substrate for maintenance of idiopathic human atrial fibrillation: Efficacy of radiofrequency ablation using nonfluoroscopic catheter guidance

• Published in: Circulation (New York, N.Y.) Vol. 100; no. 20; pp. 2085 - 2092
• Main Authors: ERNST, S, SCHLÜTER, M, FEIFAN OUYANG, KHANEDANI, A, CAPPATO, R, HEBE, J, VOLKMER, M, ANTZ, M, KUCK, K.-H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 16.11.1999; American Heart Association, Inc
• Subjects: Atrial Fibrillation - therapy; Biological and medical sciences; Biosensing Techniques; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - instrumentation; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Human; Arrhythmia; Treatment efficiency; Atrial fibrillation; Instrumentation therapy; Catheter; Cardiovascular disease; Radiofrequency; Ablation; Excitability disorder; Guidance; Treatment; Heart mapping; Heart disease; Accessory bundle
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.100.20.2085

Catheter ablative techniques to modify the substrate to maintain atrial fibrillation (AF) require the creation of continuous radiofrequency current-induced ablation lines. This study was designed to assess the efficacy and safety of nonfluoroscopic mapping in this setting. A total of 45 consecutive patients with idiopathic AF were studied. The first 13 underwent ablation confined to the left atrium by creating a circular line isolating the pulmonary vein ostia and a second line connecting the former with the mitral annulus. Subsequently, 12 of these patients underwent a procedure confined to the right atrium (RA), where attempts were made to create an isthmus line between the inferior vena cava and the tricuspid annulus, an anterior line connecting the tricuspid annulus with the superior vena cava, and an intercaval line between the ostia of the inferior and superior venae cavae. In the last 32 patients, only the RA approach was performed. Technical difficulties prevented the creation of the intended left atrial line pattern: all patients experienced recurrences. A 100% recurrence rate was also observed after subsequent RA ablation, despite creation of a complete line pattern in 4 of 12 patients. Of the final 32 patients, AF recurred in 94%; a complete ablation line pattern had been achieved in 18 patients (56%), 16 of whom had recurrences. The electroanatomically-guided creation of extended radiofrequency current lesions is technically feasible only in the RA. However, procedural success in the RA does not suppress recurrences of AF in the majority of patients.