Tuesday, 28 June 2005
EUROPACE 2005
and left atrial substrate (perpetuation). Extensive encircling isolation of
ipsilateral pulmonary vein (EEPVI) is highly effective for cure of A Fib.
The purpose of this study was to evaluate the predictive factors for long
term successful EEPVI.
Methods and results: 48 patients (M/F: 32/16, Age: 61yrs) with drug
resistant paroxysmal A Fib who underwent EEPVI were enrolled. EEPVI
was performed using 4mm tip catheter with the CARTO system or using
8mm tip catheter. The complete electrical left atrial- pulmonary vein
disconnection was obtained in all patients. After the EEPVI, we divided
two groups according to the perpetuation of induced A Fib over 5 minutes
(P(-) group: n=26 vs P(+) group: n=22). The recurrence rate of clinical
symptomatic A Fib and atrial flutter in P(-) group (4/26 (15.3%)) was
significantly lower compared with that in P(+) group (12/22 (54.5%)).
Moreover, left atrial flutter was observed in 6 patients, and we tried the
additional linear ablation line in some cases.
Conclusion: perpetuation of induced A Fib indicated the existence of
residual or created substrate in the left atrium. So, perpetuation of induced
A Fib can predict the recurrence after extensive encircling isolation of
ipsilateral pulmonary vein. Moreover, additional linear ablation may be
required in such cases with perpetuation of induced A Fib after EEPVI.
672
Impact of pulmonary veins atypical anatomy on atrial fibrillation
ablation outcomes in segmental ostial approach
P. Urbanek 1, L. Szumowski 1, M. Zagrodzka 2, K. Onish 3, I. Bestry 2,
R Derejko t , R. Kepski t, E. Szufladowicz t , R. Bodalski t , F. Walczak t
]Inst. of Cardiology, Warsaw, Poland; 2Military Inst. of Medicine,
Warsaw, Poland; 3Inst. of Pulmonary Diseases, Warsaw, Poland
The anatomic arrangement of pulmonary veins(PVs) is variable. The aim
of this study was to determine the influence of PVs atypical anatomy
assessed by spiral computer tomography(SCT) on segmental ostial atrial
fibrillation ablation outcomes.
Methods: In the group of 80 patients who were scheduled for segmental
ostial ablation of PVs, spiral computer tomography was performed in
64. The study group was divided into 2 subgroups: group I - typical
anatomy (4 separated PVs ostia) and group II - atypical anatomy (more
or less than 4 separated PVs ostia).
All patients underwent segmental ostial ablation using circumferential
mapping catheter. Only veins with PV potentials were ablated.
Results: Group I consisted of 57 pts (89%) and group II - 7 pts (11%). In
group II 4pts had additional right medial PV ostium, 2 had left common
ostium, 1 patient had 2 common ostia - left and right (RF results, see
table).
Typical anatomy (gr. I) n=57
Atypical anatomy (gr. II) n=7
FU (months)
No AF
Clinical
Improvement
AF
19±16
11±6
79% (45)
57% (4)
12% (7)
14% (1)
9% (5)
29% (2)
Conclusions: Atypical anatomy of PVs seems to reduce the success rate
of ablation in segmental ostial approach despite detailed assessment in
SCT. The analysis of a larger cohort of patients is required to confirm
these observations.
673
TEE evaluation of pulmonary vein flow and left ventricular
function after circumferential RF catheter ablation of pulmonary
veins due to AF. A prospective follow-up study
A. Gerber, M. Trusz-Gluza, J. Krauze, A. Rybicka-Musialik, K. Wita,
C. Czerwinski, A-M. Wnuk-Wojnar, W. Wrobel, M. Nowak
Slaska Akademia Medyczna, I Klinika Kardiologii, Katowice, Poland
Aim of the study: to assess whether successful circumferential pulmonary veins RF catheter ablation (CPVA) influences left ventricular
function in short-term follow-up; and to investigate a possible, early
pulmonary vein stenosis in asymptomatic pts.
Methods and results: Forty one pts, with refractory to antiarrhythmic
drugs and highly symptomatic episodes of atrial fibrillation
(AF), underwent CPVA according to Pappone technique. 3-dimensional
electroanatomic CARTO system was used. In all pts transoesophageal
echocardiography examination (TEE) was performed before the procedure, with following data assessment: left ventricular ejection fraction
(LVEF, %), left atrium end-systolic area (LA, cm2), E/A diastolic mitral
flow ratio, isovolumetric relaxation time (IVRT, ms), E wave deceleration time (DT, ms) PV ostial diameter (mm), PV Doppler flow velocities
(ms-t), regarding left and right superior and inferior PVs (LSPV, RSPV,
LIPV, RIPV). Pts were then followed-up by mean period of 90 days,
with TEE data evaluation.
All pts were free from symptomatic AF by the time of follow-up.
We found no difference as far as diastolic LV function parameters are
concerned. In 3 pts (7,3%) turbulent and elevated PV maximal flows
were observed, indicating PV stenosis. TEE data were confirmed by CT
scans in those pts. Only 1 pt had mild clinical symptoms of stenosis.
Statistical significant improvement in LVEF was recorded. Some results
of TEE data are shown in table 1.
Table 1. Some resuks of TEE examination at baseline and FU
EF LA E/A
(%) area
base 61 18 1,0
FU 64 18 0,9
p
0.01 NS NS
Vmax
Diameter
LSPV LIPV RSPV RIPV LSPV LIPV RIPV RSPV
0,6
0,6
NS
0,3
0,3
NS
0,5
0,9
NS
0,5
0,3
NS
10
9,5
NS
4
5,4
NS
3
4,5
NS
7
7
NS
Conclusions: Preliminary results of TEE follow-up of pts referred for
catheter ablation of AF, show an evident improvement in LV ejection
fraction, with no change in diastolic filling pattern despite of successful
restoration of sinus rhytm. PV stenosis was observed in 3 pts, however,
only in 1 case with corresponding mild clinical symptoms.
674
Catheter ablation for persistent and permanent atrial fibrillation:
left atrial approach versus biatrial approach
L. Calo 1, F. Lamberti 2, M.L. Loricchio 2, E. De Ruvo 2, F. Colivicchi 2,
C. Pandozi 2, M. Santini 2
]Marino, Italy; 2San Filippo Neri Hospital, Cardiology, Rome, Italy
Background: catheter ablation for atrial fibrillation (AF) has a low
efficacy in patients (pts) with persistent and permanent AF.
Methods: eighty patients with persistent (43 pts) and permanent AF
(37 pts) highly symptomatic and refractory to anti-arrhythmic drugs
(AAD) (28 women, 58.6 4- 8.9 years, 67 pts with structural heart disease) were prospectively randomized to 2 different ablation approaches
guided by electro-anatomical mapping (CARTO). Forty pts underwent
to circumferential pulmonary vein (PV) ablation in combination with
cavotricuspid isthmus ablation (approach A). In the other 40 pts the
following lesions were added in the right atrium (approach B):
1) Intercaval posterior line;
2) Intercaval septal line through the fossa ovalis and the coronary sinus
where a circumferential line around the ostium was performed;
3) Electrical disconnection of the superior vena cava. The clinical
characteristics of the pts in the 2 groups did not differ significantly.
All pts continued previously ineffective AAD at least for 6 months.
Results: during a mean follow-up of 14 4- 5 months, 61% of patients
(16/41) who underwent left atrial and cavo-tricuspid ablation were AF
free, compared with 85% of patients (33/39) who underwent biatrial
ablation (P=0.022, log-rank test). The mean duration of procedure and
fluoroscopy times for the approach A were 1654-26 and 304-10 minutes, and for the approach B were 2264-30 and 404-13 minutes. An
hemothorax and a retroperitoneal hematoma occurred in the left atrial
ablation group. During the follow-up left atrial flutter, which resolved
spontaneously, developed in 6 pts.
Conclusion: this study first demonstrates that in pts with persistent and
permanent AF the circumferential PV ablation in combination with linear
Europace Supplements, Vol. 7, June 2005
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