Abstract:
BACKGROUND:Complete circumferential antral ablation may not be necessary for successful pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). OBJECTIVE:We examined the feasibility of a noncircumferential approach limited to segments of the antra required for PV-atrial conduction. METHODS:During ablation for paroxysmal AF, each PV antrum was divided into six segments, and ablation was sequentially targeted to antral segments with the earliest activity until bidirectional isolation was achieved. Ablation at the ostium was avoided. Patients requiring complete circumferential ablation (circumferential group) were compared with those undergoing incomplete antral ablation (noncircumferential group) with respect to freedom from symptomatic atrial arrhythmia, procedure, and ablation times. RESULTS:Ninety-nine patients underwent ablation with successful isolation of PVs (n = 37 circumferential; n = 62 noncircumferential). There were no significant differences in age, gender, AF duration, or LA size. Procedure time (202 ± 45 vs. 185 ± 47 minutes; P = .06) and ablation time (51 ± 15 vs. 41 ± 14 minutes; P = .004) were shorter in the noncircumferential group. During follow-up (12 ± 6 months), freedom from symptomatic recurrence was 73% in both groups (P = .97), with organized atrial tachycardia being more common in the circumferential group (P = .06). In 22 patients undergoing repeat study, PV reconnection was demonstrated in 82% and 81% of PVs in each group. Reconnection in the noncircumferential group occurred in previously ablated segments in 10 (77%) of 13 cases. CONCLUSIONS:Noncircumferential antral ablation achieves similar success rates with shorter procedure and ablation times than circumferential ablation. Greater attention should be focused on producing permanent lesions rather than on completing antral encirclement after isolation is achieved.
journal_name
Heart Rhythmjournal_title
Heart rhythmauthors
Sy RW,Gula LJ,Leong-Sit P,Klein GJ,Yee R,Krahn AD,Bentley C,Razak S,Skanes ACdoi
10.1016/j.hrthm.2010.09.069subject
Has Abstractpub_date
2011-01-01 00:00:00pages
16-22issue
1eissn
1547-5271issn
1556-3871pii
S1547-5271(10)01012-Xjournal_volume
8pub_type
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