Background: We conducted a randomized, controlled trial of circumferential pulmonary-vein ablation for the treatment of chronic atrial fibrillation. Methods: A total of 146 patients with a mean(± SD) age of 57...Background: We conducted a randomized, controlled trial of circumferential pulmonary-vein ablation for the treatment of chronic atrial fibrillation. Methods: A total of 146 patients with a mean(± SD) age of 57± 9 years who had chronic atrial fibrillation were randomly assigned to receive amiodarone and undergo two cardioversions during the first three months alone(the control group) or in combination with circumferential pulmonary-vein ablation. Cardiac rhythm was assessed with daily telephonic transmissions for one year. The left atrial diameter and the severity of symptoms were assessed at 12 months. Results: Among the 77 patients assigned to undergo circumferential pulmonary-vein ablation, ablation was repeated because of recurrent atrial fibrillation in 26 percent of patients and atypical atrial flutter in 6 percent. An intention-to-treat analysis showed that 74 percent of patients in the ablation group and 58 percent of those in the control group were free of recurrent atrial fibrillation or flutter without antiarrhythmic-drug therapy at one year(P=0.05). Among the 69 patients in the control group, 53(77 percent) crossed over to undergo circumferential pulmonary-vein ablation for recurrent atrial fibrillation by one year and only 3(4 percent) were in sinus rhythm without antiarrhythmic-drug therapy or ablation. There were significant decreases in the left atrial diameter(12± 11 percent, P< 0.001) and the symptom severity score(59± 21 percent, P< 0.001) among patients who remained in sinus rhythm after circumferential pulmonary-vein ablation. Except for atypical atrial flutter, there were no complications attributable to circumferential pulmonary-vein ablation. Conclusions: Sinus rhythm can be maintained long term in the majority of patients with chronic atrial fibrillation by means of circumferential pulmonary-vein ablation independently of the effects of antiarrhythmic-drug therapy, cardioversion, or both. The maintenance of sinus rhythm is associated with a significant decrease in both the severity of symptoms and the left atrial diameter.展开更多
OBJECTIVES: We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation(AF) undergoing circumferential pulmonary vein ablation( CPVA). BACKGROUND: No data are available on feasibility of...OBJECTIVES: We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation(AF) undergoing circumferential pulmonary vein ablation( CPVA). BACKGROUND: No data are available on feasibility of remote navigation for AF ablation. METHODS: Forty patients underwent CPVA for symptomatic AF using th e NIOBE II remote magnetic system(Stereotaxis Inc., St. Louis, Missouri). Ablati on was performed with a 4-mm tip, magnetic catheter(65℃, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field(0.08-T), and a motor dr ive(Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system(Stereotaxis Inc.). End point of ablation was voltage abatement >90%of bipolar electrogram amplitude. RESULTS: Remote ablation was s uccessful in 38 of 40 patients without complications. The median mapping and abl ation time was 152.5 min(range, 90 to 380 min) but was much longer in the first 12 patients(192.5 min vs. 148 min; p=0.012). Median ablation time was 49.5 min(r ange, 17 to 154 min), but it was much shorter in the last 28 patients than in th e first 12 patients(49 min vs. 70 min; p=0.021). Patients receiving remote ablat ion had longer procedure times than control patients(p< 0.001) with similar mapp ing time but shorter ablation time on right-sided pulmonary veins. Many more ma pping points regardless of their location were collected remotely(p< 0.001). CON CLUSIONS: Remote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all pro cedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.展开更多
Background -Circumferential pulmonary vein ablation (CPVA) is effective in cu ring atrial fibrillation(AF), but newonset left atrial tachycardia(AT) is a pote ntial complication. We evaluated whether a modified CPVA a...Background -Circumferential pulmonary vein ablation (CPVA) is effective in cu ring atrial fibrillation(AF), but newonset left atrial tachycardia(AT) is a pote ntial complication. We evaluated whether a modified CPVA approach including addi tional ablation lines on posterior wall and the mitral isthmus would reduce the incidence of AT after PV ablation. Methods and Results -A total of 560 patients (291 men, 52%; age, 56.5±7.3 years) entered the study; 280 were randomized to CPVA alone(group 1) and 280 to modified CPVA(group 2). The primary end point was freedom from AT after the procedure. In group 1, 28 patients(10%) experienced new-onset AT, and 41(14.3%) experienced recurrent AF. In group 2, 11 patients( 3.9%) experienced AT, and 36(12.9%) had recurrent AF. Group 1 was more likely to experience AT than group 2 (P=0.005). Freedom from AF after ablation was simi lar in both groups(P=0.57). Among those in group 1, gap-related macroreentrant AT was documented in 23 of the 28 patients(82%), and focal AT was found in 5(18 %). In group 2, gap-related macroreentrant AT was found in 8 of the 11 patient s(73%), and focal AT was seen in 3(27%). Two patients in group 1 and 1 patient in group 2 had both AT and AF. The strongest predictor of AT was the presence o f gaps(P < 0.001). Conclusions-Modified CPVAisaseffective asCPVAinpreventing AF but is associated with a lower risk of developing incessant AT.展开更多
文摘Background: We conducted a randomized, controlled trial of circumferential pulmonary-vein ablation for the treatment of chronic atrial fibrillation. Methods: A total of 146 patients with a mean(± SD) age of 57± 9 years who had chronic atrial fibrillation were randomly assigned to receive amiodarone and undergo two cardioversions during the first three months alone(the control group) or in combination with circumferential pulmonary-vein ablation. Cardiac rhythm was assessed with daily telephonic transmissions for one year. The left atrial diameter and the severity of symptoms were assessed at 12 months. Results: Among the 77 patients assigned to undergo circumferential pulmonary-vein ablation, ablation was repeated because of recurrent atrial fibrillation in 26 percent of patients and atypical atrial flutter in 6 percent. An intention-to-treat analysis showed that 74 percent of patients in the ablation group and 58 percent of those in the control group were free of recurrent atrial fibrillation or flutter without antiarrhythmic-drug therapy at one year(P=0.05). Among the 69 patients in the control group, 53(77 percent) crossed over to undergo circumferential pulmonary-vein ablation for recurrent atrial fibrillation by one year and only 3(4 percent) were in sinus rhythm without antiarrhythmic-drug therapy or ablation. There were significant decreases in the left atrial diameter(12± 11 percent, P< 0.001) and the symptom severity score(59± 21 percent, P< 0.001) among patients who remained in sinus rhythm after circumferential pulmonary-vein ablation. Except for atypical atrial flutter, there were no complications attributable to circumferential pulmonary-vein ablation. Conclusions: Sinus rhythm can be maintained long term in the majority of patients with chronic atrial fibrillation by means of circumferential pulmonary-vein ablation independently of the effects of antiarrhythmic-drug therapy, cardioversion, or both. The maintenance of sinus rhythm is associated with a significant decrease in both the severity of symptoms and the left atrial diameter.
文摘OBJECTIVES: We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation(AF) undergoing circumferential pulmonary vein ablation( CPVA). BACKGROUND: No data are available on feasibility of remote navigation for AF ablation. METHODS: Forty patients underwent CPVA for symptomatic AF using th e NIOBE II remote magnetic system(Stereotaxis Inc., St. Louis, Missouri). Ablati on was performed with a 4-mm tip, magnetic catheter(65℃, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field(0.08-T), and a motor dr ive(Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system(Stereotaxis Inc.). End point of ablation was voltage abatement >90%of bipolar electrogram amplitude. RESULTS: Remote ablation was s uccessful in 38 of 40 patients without complications. The median mapping and abl ation time was 152.5 min(range, 90 to 380 min) but was much longer in the first 12 patients(192.5 min vs. 148 min; p=0.012). Median ablation time was 49.5 min(r ange, 17 to 154 min), but it was much shorter in the last 28 patients than in th e first 12 patients(49 min vs. 70 min; p=0.021). Patients receiving remote ablat ion had longer procedure times than control patients(p< 0.001) with similar mapp ing time but shorter ablation time on right-sided pulmonary veins. Many more ma pping points regardless of their location were collected remotely(p< 0.001). CON CLUSIONS: Remote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all pro cedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.
文摘Background -Circumferential pulmonary vein ablation (CPVA) is effective in cu ring atrial fibrillation(AF), but newonset left atrial tachycardia(AT) is a pote ntial complication. We evaluated whether a modified CPVA approach including addi tional ablation lines on posterior wall and the mitral isthmus would reduce the incidence of AT after PV ablation. Methods and Results -A total of 560 patients (291 men, 52%; age, 56.5±7.3 years) entered the study; 280 were randomized to CPVA alone(group 1) and 280 to modified CPVA(group 2). The primary end point was freedom from AT after the procedure. In group 1, 28 patients(10%) experienced new-onset AT, and 41(14.3%) experienced recurrent AF. In group 2, 11 patients( 3.9%) experienced AT, and 36(12.9%) had recurrent AF. Group 1 was more likely to experience AT than group 2 (P=0.005). Freedom from AF after ablation was simi lar in both groups(P=0.57). Among those in group 1, gap-related macroreentrant AT was documented in 23 of the 28 patients(82%), and focal AT was found in 5(18 %). In group 2, gap-related macroreentrant AT was found in 8 of the 11 patient s(73%), and focal AT was seen in 3(27%). Two patients in group 1 and 1 patient in group 2 had both AT and AF. The strongest predictor of AT was the presence o f gaps(P < 0.001). Conclusions-Modified CPVAisaseffective asCPVAinpreventing AF but is associated with a lower risk of developing incessant AT.
