Left mitral isthmus ablation associated with PV isolation: Long-term results of a prospective randomized study

被引:172
作者
Fassini, G
Riva, S
Chiodelli, R
Trevisi, N
Berti, M
Carbucicchio, C
Maccabelli, G
Giraldi, F
Della Bella, P
机构
[1] Univ Milan, Arrhythmia Unit, Ctr Cardiol Monzino, Inst Cardiol, I-20138 Milan, Italy
[2] Univ Milan, Clin Electrophysiol Lab, Ctr Cardiol Monzino, Inst Cardiol, I-20138 Milan, Italy
关键词
atrial fibrillation; catheter ablation; mitral isthmus; linear lesion;
D O I
10.1111/j.1540-8167.2005.50192.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Left Mitral Isthmus Ablation and PV Isolation. Background: The deployment of an ablation line connecting the left inferior PV to the mitral annulus (mitral isthmus line [MIL]) enhances the efficacy of pulmonary vein disconnection (PVD) in preventing atrial fibrillation (AF) recurrences. Objectives: To investigate the long-term effect of the additional linear lesion in a prospective randomized study. Methods: One hundred and eighty-seven patients (37 females, mean age: 55 +/- 11 years) with paroxysmal (126) or persistent (61 patients) AF, were prospectively randomized into two groups: PVD (group A, 92 patients) or PVD combined with MIL (group B, 95 patients), performed by means of an irrigated-tip ablation catheter. Results: Successful disconnection of all PVs was achieved in all patients. A bidirectional block (BB) along the left atrial isthmus was obtained in 72 of 95 (76%) patients in group B, most of whom required additional RF pulses from within the distal CS. A transient ischemic attack occurred in 1 patient of group A, and a cardiac tamponade occurred in 1 patient of group B. At 1 year, 53 +/- 5% (group A) and 71 +/- 5% (group B) remained arrhythmia free (P = 0.01); subgroup analysis highlights a higher improvement among patients with persistent AF (74 +/- 9% vs 36 +/- 9%; P < 0.01) than what was observed in paroxysmal AF (76 +/- 6% vs 62 +/- 6%; P < 0.05); antiarrhythmic drugs were continued in 56% and 50%, respectively, in groups A and B (P = ns). Conclusions: The addition of mitral isthmus line to the PV disconnection allows a significant improvement of sinus rhythm maintenance rate, particularly in patients with persistent AF, without the risk for major complications.
引用
收藏
页码:1150 / 1156
页数:7
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