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Is There Still a Role for Right Atrial Ablation in Patients with Atrial Fibrillation?

  • M. L. Loricchio
  • L. Calo’
  • F. Lamberti
  • A. Castro
  • A. Boggi
  • C. Pandozi
  • M. Santini
Conference paper

Abstract

Radiofrequency (RF) transcatheter ablation has been recently proposed to cure atrial fibrillation (AF). Initial studies tried to replicate the surgical “maze” procedure, performing linear lesions in the right atrium (RA) and/or the left atrium [1-5]. The first report of RF catheter ablation suggested that linear lesions in the RA are able to cure AF [1]. Additional studies have been done using only right atrial ablation to prevent AF recurrence, with varying results but without serious complications [2-5]. More recently, several reports have pointed to the importance of the posterior region of the left atrium, particularly the pulmonary veins, as a critical area in the initiation and maintenance of AF [6-10]. However, the approaches used vary, the reproducibility of the results is uncertain, and the studies are not controlled. Furthermore, these ablative therapies are not without risks [11]. Haïssaguerre et al. [7] reported a success rate of 71% with a 3% incidence of pulmonary vein stenosis in patients with paroxysmal AF who underwent focal ablation in the pulmonary veins. A different approach, circumferential pulmonary vein ablation, proved to be effective in 80% of patients, with an 0.8% incidence of major complications [8]. Nowadays, the low efficacy of right atrial ablation procedures is generally accepted, but some issues remain to be clarified. Can we increase the efficacy of the linear lesions in the RA with new mapping systems? What is the most effective lesion design in the RA, and what is the effect of these lesions on quality of life?

Keywords

Atrial Fibrillation Pulmonary Vein Catheter Ablation Superior Vena Cava Paroxysmal Atrial Fibrillation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Reference

  1. 1.
    Haïssaguerre M, Jaïs P, Shah DC et al (1996) Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 7:1132–1144PubMedCrossRefGoogle Scholar
  2. 2.
    Gaita F, Riccardi R, Calo L et al (1998) Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation. Electrophysiological findings and ablation results. Circulation 97:2136–2145PubMedCrossRefGoogle Scholar
  3. 3.
    Pappone C, Oreto G, Lamberti F et al (1999) Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system. Circulation 100:1203–1208PubMedCrossRefGoogle Scholar
  4. 4.
    Garg A, Finneran W, Mollerus M et al (1999) Right atrial compartimentalization using radiofrequency catheter ablation for management of patients with refractory atrial fibrillation. J Cardiovasc Electrophysiol 10:763–771PubMedCrossRefGoogle Scholar
  5. 5.
    Natale A, Leonelli F, Beheiry S et al (2000) Catheter ablation approach on the right side only for paroxysmal atrial fibrillation therapy: long-term results. Pacing Clin Electrophysiol 23:224–233PubMedCrossRefGoogle Scholar
  6. 6.
    Haïssaguerre M, Jaïs P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRefGoogle Scholar
  7. 7.
    Haïssaguerre M, Jaïs P, Shah DC et al (2000) Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 101:1409–1410PubMedCrossRefGoogle Scholar
  8. 8.
    Pappone C, Rosanio S, Oreto G et al (2000) Circumferential radiofrequency ablation of pulmunary vein ostia: a new approach for curing atrial fibrillation. Circulation 102:2619–2628PubMedCrossRefGoogle Scholar
  9. 9.
    Pappone C, Oreto G, Rosanio S et al (2001) Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation. Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 104:25392544Google Scholar
  10. 10.
    Marrouche NF, Dresing T, Cole C et al (2002) Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation. J Am Coll Cardiol 40:464–474PubMedCrossRefGoogle Scholar
  11. 11.
    Yu WC, Hsu TL, Tai CT et al (2001) Acquired pulmonary stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 12:887–89PubMedCrossRefGoogle Scholar
  12. 12.
    Gaita F, Ca16 L, Riccardi R et al (2001) Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation. J Am Coll Cardiol. 37:534–534PubMedCrossRefGoogle Scholar
  13. 13.
    Tondo C, Scherlag BJ, Otomo K et al (1997) Critical atrial site for ablation of pacing-induced atrial fibrillation in the normal dog heart. J Cardiovasc Electrophysiol 8:1255–1265PubMedCrossRefGoogle Scholar
  14. 14.
    Tsai C, Tai C, Hsieh M et al (2000) Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radiofrequency ablation. Circulation 102:67–74PubMedCrossRefGoogle Scholar
  15. 15.
    Goya M, Ouyang F, Ernst S et al (2002) Electroanatomic mapping and catheter ablation of breakthroughs from the right atrium to the superior vena cava in patients with atrial fibrillation. Circulation 106:1317–1320PubMedCrossRefGoogle Scholar
  16. 16.
    Chen YJ, Chen CY, Yeh HI et al (2002) Electrophysiology and arrhythmogenic activity of single cardiomyocytes from canine superior vena cava. Circulation 105: 2679–2685PubMedCrossRefGoogle Scholar
  17. 17.
    Schauerte P, Scherlag BJ, Pitha J et al (2000) Catheter ablation of cardiac autonomic nerves for prevention of vagal atrial fibrillation. Circulation 102:2774–2780PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • M. L. Loricchio
    • 1
  • L. Calo’
    • 1
  • F. Lamberti
    • 1
  • A. Castro
    • 1
  • A. Boggi
    • 1
  • C. Pandozi
    • 1
  • M. Santini
    • 1
  1. 1.Department of CardiologyOspedale San Filippo NeriRomeItaly

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