Skip to main content
Erschienen in: Herzschrittmachertherapie + Elektrophysiologie 4/2017

24.04.2017 | Original Contribution

Catheter ablation of persistent atrial fibrillation

Long-term results of circumferential pulmonary vein ablation in combination with a linear lesion at the roof of the left atrium

verfasst von: Klaus Kettering, MD, Dag-Hau Yim, Caroline Albert, Felix Gramley, MD

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. However, catheter ablation of persistent atrial fibrillation is still a challenge. Various relatively complex ablation strategies exist and their results are not very favorable. Therefore, the aim of our study was to evaluate a well-defined reasonable approach to catheter ablation of persistent atrial fibrillation. The strategy consisted of a circumferential pulmonary vein ablation in combination with a linear lesion at the roof of the left atrium.

Methods

A total of 150 patients with symptomatic persistent atrial fibrillation were enrolled in this study. All patients underwent catheter ablation of persistent atrial fibrillation using the abovementioned approach.

Results

The ablation procedure could be performed as planned in all 150 patients. Five years after catheter ablation, the success rate was 71.3% (no arrhythmia recurrence in 107 out of 150 patients). There were no major complications during long-term follow-up.

Conclusion

Catheter ablation of persistent atrial fibrillation can be performed safely and effectively using this ablation strategy providing favorable long-term follow-up results.
Literatur
1.
Zurück zum Zitat Kettering K, Al-Ghobainy R, Wehrmann M, Vonthein R, Mewis C (2006) Atrial linear lesions: feasibility using cryoablation. Pacing Clin Electrophysiol 29:283–289CrossRefPubMed Kettering K, Al-Ghobainy R, Wehrmann M, Vonthein R, Mewis C (2006) Atrial linear lesions: feasibility using cryoablation. Pacing Clin Electrophysiol 29:283–289CrossRefPubMed
2.
Zurück zum Zitat Oral H, Knight BP, Ozaydin M, Chugh A, Lai SW, Scharf C, Hassan S, Greenstein R, Han JD, Pelosi F, Strickberger SA, Morady F (2002) Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights. Circulation 106(10):1256–1262CrossRefPubMed Oral H, Knight BP, Ozaydin M, Chugh A, Lai SW, Scharf C, Hassan S, Greenstein R, Han JD, Pelosi F, Strickberger SA, Morady F (2002) Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights. Circulation 106(10):1256–1262CrossRefPubMed
3.
Zurück zum Zitat Haïssaguerre M, Shah DC, Jaïs P, Hocini M, Yamane T, Deisenhofer I, Garrigue S, Clémenty J (2000) Mapping-guided ablation of pulmonary veins to cure atrial fibrillation. Am J Cardiol 86(suppl):9K–19KCrossRefPubMed Haïssaguerre M, Shah DC, Jaïs P, Hocini M, Yamane T, Deisenhofer I, Garrigue S, Clémenty J (2000) Mapping-guided ablation of pulmonary veins to cure atrial fibrillation. Am J Cardiol 86(suppl):9K–19KCrossRefPubMed
4.
Zurück zum Zitat Gerstenfeld EP, Guerra P, Sparks PB, Hattori K, Lesh MD (2001) Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers. J Cardiovasc Electrophysiol 12(8):900–908CrossRefPubMed Gerstenfeld EP, Guerra P, Sparks PB, Hattori K, Lesh MD (2001) Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers. J Cardiovasc Electrophysiol 12(8):900–908CrossRefPubMed
5.
Zurück zum Zitat Marrouche NF, Dresing T, Cole C, Bash D, Saad E, Balaban K, Pavia SV, Schweikert R, Saliba W, Abdul-Karim A, Pisano E, Fanelli R, Tchou P, Natale A (2002) Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies. J Am Coll Cardiol 40(3):464–474CrossRefPubMed Marrouche NF, Dresing T, Cole C, Bash D, Saad E, Balaban K, Pavia SV, Schweikert R, Saliba W, Abdul-Karim A, Pisano E, Fanelli R, Tchou P, Natale A (2002) Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies. J Am Coll Cardiol 40(3):464–474CrossRefPubMed
6.
Zurück zum Zitat Swartz J, Pellersels G, Silvers J, Patten L, Cervantez D (1994) A catheter-based curative approach to atrial fibrillation in humans. Circulation 90(4.2):I335 (abstract) Swartz J, Pellersels G, Silvers J, Patten L, Cervantez D (1994) A catheter-based curative approach to atrial fibrillation in humans. Circulation 90(4.2):I335 (abstract)
7.
Zurück zum Zitat Haïssaguerre M, Jaïs P, Shah DC, Gencel L, Pradeau V, Garrigues S, Chouairi S, Hocini M, Le-Metayer P, Roudaut R, Clémenty J (1996) Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 7(12):1132–1144CrossRefPubMed Haïssaguerre M, Jaïs P, Shah DC, Gencel L, Pradeau V, Garrigues S, Chouairi S, Hocini M, Le-Metayer P, Roudaut R, Clémenty J (1996) Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 7(12):1132–1144CrossRefPubMed
8.
Zurück zum Zitat Ernst S, Schluter M, Ouyang F, Khanedani A, Cappato R, Hebe J, Volkmer M, Antz M, Kuck KH (1999) Modification of the substrate for maintenance of idiopathic human atrial fibrillation: efficacy of radiofrequency ablation using nonfluoroscopic catheter guidance. Circulation 100(20):2085–2092CrossRefPubMed Ernst S, Schluter M, Ouyang F, Khanedani A, Cappato R, Hebe J, Volkmer M, Antz M, Kuck KH (1999) Modification of the substrate for maintenance of idiopathic human atrial fibrillation: efficacy of radiofrequency ablation using nonfluoroscopic catheter guidance. Circulation 100(20):2085–2092CrossRefPubMed
9.
Zurück zum Zitat Jaïs P, Hocini M, Hsu LF, Sanders P, Scavee C, Weerasooriya R, Macle L, Raybaud F, Garrigue S, Shah DC, Le-Metayer, Clémenty J, Haïssaguerre M (2004) Technique and results of linear ablation at the mitral isthmus. Circulation 110(19):2996–3002CrossRefPubMed Jaïs P, Hocini M, Hsu LF, Sanders P, Scavee C, Weerasooriya R, Macle L, Raybaud F, Garrigue S, Shah DC, Le-Metayer, Clémenty J, Haïssaguerre M (2004) Technique and results of linear ablation at the mitral isthmus. Circulation 110(19):2996–3002CrossRefPubMed
10.
Zurück zum Zitat Oral H, Chugh A, Lemola K, Cheung P, Hall B, Good E, Han J, Tamirisa K, Bogun F, Pelosi F, Morady F (2004) Noninducibility of atrial fibrillation as an end point of left atrial circumferential ablation for paroxysmal atrial fibrillation: a randomized study. Circulation 110(18):2797–2801CrossRefPubMed Oral H, Chugh A, Lemola K, Cheung P, Hall B, Good E, Han J, Tamirisa K, Bogun F, Pelosi F, Morady F (2004) Noninducibility of atrial fibrillation as an end point of left atrial circumferential ablation for paroxysmal atrial fibrillation: a randomized study. Circulation 110(18):2797–2801CrossRefPubMed
11.
Zurück zum Zitat Avitall B, Helms RW, Koblish JB, Sieben W, Kotov AV, Gupta GN (1999) The creation of linear contiguous lesions in the atria with an expandable loop catheter. J Am Coll Cardiol 33(4):972–984CrossRefPubMed Avitall B, Helms RW, Koblish JB, Sieben W, Kotov AV, Gupta GN (1999) The creation of linear contiguous lesions in the atria with an expandable loop catheter. J Am Coll Cardiol 33(4):972–984CrossRefPubMed
12.
Zurück zum Zitat Mitchell MA, McRury ID, Haines DE (1998) Linear atrial ablations in a canine model of chronic atrial fibrillation: morphological and electrophysiological observations. Circulation 97(12):1176–1185CrossRefPubMed Mitchell MA, McRury ID, Haines DE (1998) Linear atrial ablations in a canine model of chronic atrial fibrillation: morphological and electrophysiological observations. Circulation 97(12):1176–1185CrossRefPubMed
13.
Zurück zum Zitat Schwartzman D, Kuck KH (1998) Anatomy-guided linear atrial lesions for radiofrequency catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol 21(10):1959–1978CrossRefPubMed Schwartzman D, Kuck KH (1998) Anatomy-guided linear atrial lesions for radiofrequency catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol 21(10):1959–1978CrossRefPubMed
14.
Zurück zum Zitat Ouyang F, Baensch D, Ernst S, Schaumann A, Hachiya H, Chen M, Chun J, Falk P, Khanedani A, Antz M, Kuck KH (2004) Complete isolation of the left atrium surrounding the pulmonary veins. New insights from the double-Lasso technique in paroxysmal atrial fibrillation. Circulation 110:2090–2096CrossRefPubMed Ouyang F, Baensch D, Ernst S, Schaumann A, Hachiya H, Chen M, Chun J, Falk P, Khanedani A, Antz M, Kuck KH (2004) Complete isolation of the left atrium surrounding the pulmonary veins. New insights from the double-Lasso technique in paroxysmal atrial fibrillation. Circulation 110:2090–2096CrossRefPubMed
15.
Zurück zum Zitat Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, Schaumann A, Chun J, Falk P, Hennig D, Liu X, Baensch D, Kuck KH (2005) Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins. Lessons from double Lasso technique. Circulation 111:127–135CrossRefPubMed Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, Schaumann A, Chun J, Falk P, Hennig D, Liu X, Baensch D, Kuck KH (2005) Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins. Lessons from double Lasso technique. Circulation 111:127–135CrossRefPubMed
16.
Zurück zum Zitat Ouyang F, Ernst S, Chun J, Baensch D, Li Y, Schaumann A, Mavrakis H, Liu X, Deger FT, Schmidt B, Xue Y, Cao J, Hennig D, Huang H, Kuck KH, Antz M (2005) Electrophysiological findings during ablation of persistent atrial fibrillation with electroanatomic mapping and double Lasso catheter technique. Circulation 112:3038–3048CrossRefPubMed Ouyang F, Ernst S, Chun J, Baensch D, Li Y, Schaumann A, Mavrakis H, Liu X, Deger FT, Schmidt B, Xue Y, Cao J, Hennig D, Huang H, Kuck KH, Antz M (2005) Electrophysiological findings during ablation of persistent atrial fibrillation with electroanatomic mapping and double Lasso catheter technique. Circulation 112:3038–3048CrossRefPubMed
17.
Zurück zum Zitat Kettering K, Greil G, Fenchel M, Kramer U, Weig H, Busch M, Miller S, Sieverding L, Laszlo R, Schreieck J (2009) Catheter ablation of atrial fibrillation using the Navx-/ Ensite-system and a CT-/MRI-guided approach. Clin Res Cardiol 98:285–296CrossRefPubMed Kettering K, Greil G, Fenchel M, Kramer U, Weig H, Busch M, Miller S, Sieverding L, Laszlo R, Schreieck J (2009) Catheter ablation of atrial fibrillation using the Navx-/ Ensite-system and a CT-/MRI-guided approach. Clin Res Cardiol 98:285–296CrossRefPubMed
18.
Zurück zum Zitat Kettering K, Greil GF, Busch M, Miller S, Sieverding L, Schreieck J (2006) Catheter ablation of atrial fibrillation: ongoing atrial fibrillation inside a single pulmonary vein after successful electrical disconnection and restoration of sinus rhythm in both atria. Clin Res Cardiol 95:663–667CrossRefPubMed Kettering K, Greil GF, Busch M, Miller S, Sieverding L, Schreieck J (2006) Catheter ablation of atrial fibrillation: ongoing atrial fibrillation inside a single pulmonary vein after successful electrical disconnection and restoration of sinus rhythm in both atria. Clin Res Cardiol 95:663–667CrossRefPubMed
19.
Zurück zum Zitat Kettering K, Weig H, Busch M, Laszlo R, Schreieck J (2008) Segmental pulmonary vein ablation: success rates with and without exclusion of areas adjacent to the esophagus. J Pacing Clin Electrophysiol 31:652–659CrossRef Kettering K, Weig H, Busch M, Laszlo R, Schreieck J (2008) Segmental pulmonary vein ablation: success rates with and without exclusion of areas adjacent to the esophagus. J Pacing Clin Electrophysiol 31:652–659CrossRef
20.
Zurück zum Zitat Lockwood E, Nademanee K (2008) Electrogram-guided ablation. In: Calkins H, Jaïs P, Steinberg J (eds) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, pp 184–197 Lockwood E, Nademanee K (2008) Electrogram-guided ablation. In: Calkins H, Jaïs P, Steinberg J (eds) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, pp 184–197
21.
Zurück zum Zitat Nakagawa H, Yokoyama K, Scherlag B, Katari V, Aoyama H, Foresti S, Jackman W (2008) Ablation of autonomic ganglia. In: Calkins H, Jaïs P, Steinberg J (eds) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, pp 218–230 Nakagawa H, Yokoyama K, Scherlag B, Katari V, Aoyama H, Foresti S, Jackman W (2008) Ablation of autonomic ganglia. In: Calkins H, Jaïs P, Steinberg J (eds) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, pp 218–230
22.
Zurück zum Zitat Jaïs P, Matsuo S, Lim K, Hocini M, Knecht S, Arantès L, Bordachar P, Clémenty, Haïssaguerre M (2008) A comprehensive overview of ablation of paroxysmal, persistent, and permanent atrial fibrillation: a stepwise approach. In: Calkins H, Jaïs P, Steinberg J (eds) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, pp 251–259 Jaïs P, Matsuo S, Lim K, Hocini M, Knecht S, Arantès L, Bordachar P, Clémenty, Haïssaguerre M (2008) A comprehensive overview of ablation of paroxysmal, persistent, and permanent atrial fibrillation: a stepwise approach. In: Calkins H, Jaïs P, Steinberg J (eds) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, pp 251–259
23.
Zurück zum Zitat Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F, Bates E, Lehmann M, Vicedomini G, Augello G, Agricola E, Sala S, Santinelli V, Morady F (2006) Circumferential pulmonary vein ablation for chronic atrial fibrillation. N Engl J Med 354:934–941CrossRefPubMed Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F, Bates E, Lehmann M, Vicedomini G, Augello G, Agricola E, Sala S, Santinelli V, Morady F (2006) Circumferential pulmonary vein ablation for chronic atrial fibrillation. N Engl J Med 354:934–941CrossRefPubMed
24.
Zurück zum Zitat Karch M, Zrenner B, Deisenhofer I, Schreieck J, Ndrepepa G, Dong J, Lamprecht K, Barthel P, Luciani E, Schomig A, Schmitt C (2005) Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation 111:2875–2880CrossRefPubMed Karch M, Zrenner B, Deisenhofer I, Schreieck J, Ndrepepa G, Dong J, Lamprecht K, Barthel P, Luciani E, Schomig A, Schmitt C (2005) Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation 111:2875–2880CrossRefPubMed
25.
Zurück zum Zitat Haïssaguerre M, Jaïs P, Shah D, Arentz T, Kalusche D, Takahashi A, Garrigue S, Hocini M, Peng J, Clémenty J (2000) Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers. J Cardiovasc Electrophysiol 11:2–10CrossRefPubMed Haïssaguerre M, Jaïs P, Shah D, Arentz T, Kalusche D, Takahashi A, Garrigue S, Hocini M, Peng J, Clémenty J (2000) Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers. J Cardiovasc Electrophysiol 11:2–10CrossRefPubMed
26.
Zurück zum Zitat Calkins H, Jaïs P, Steinberg J (2008) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia Calkins H, Jaïs P, Steinberg J (2008) A practical approach to catheter ablation of atrial fibrillation, 1st edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia
27.
Zurück zum Zitat Deisenhofer I (2006) Catheter ablation of atrial fibrillation. In: Schmitt C, Deisenhofer I, Zrenner B (eds) Catheter ablation of cardiac arrhythmias, 1st edn. Steinkopff, Springer, Darmstadt, pp 216–217 Deisenhofer I (2006) Catheter ablation of atrial fibrillation. In: Schmitt C, Deisenhofer I, Zrenner B (eds) Catheter ablation of cardiac arrhythmias, 1st edn. Steinkopff, Springer, Darmstadt, pp 216–217
28.
Zurück zum Zitat Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Ngarmukos T (2004) A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 43:2044–2053CrossRefPubMed Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Ngarmukos T (2004) A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 43:2044–2053CrossRefPubMed
29.
Zurück zum Zitat Kettering K, Weig H, Busch M, Schneider K, Eick C, Weretka S, Laszlo R, Gawaz M, Schreieck J (2011) Catheter ablation of persistent atrial fibrillation: anatomically based circumferential pulmonary vein ablation in combination with a potential-guided segmental approach to achieve complete pulmonary vein isolation. J Interv Card Electrophysiol 30:63–72CrossRefPubMed Kettering K, Weig H, Busch M, Schneider K, Eick C, Weretka S, Laszlo R, Gawaz M, Schreieck J (2011) Catheter ablation of persistent atrial fibrillation: anatomically based circumferential pulmonary vein ablation in combination with a potential-guided segmental approach to achieve complete pulmonary vein isolation. J Interv Card Electrophysiol 30:63–72CrossRefPubMed
30.
Zurück zum Zitat Camm J, Lip G, De Caterina R, Savelieva I, Atar D, Hohnloser S, Hindricks G, Kirchhof P (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. doi:10.1093/eurheartj/ehs253 PubMed Camm J, Lip G, De Caterina R, Savelieva I, Atar D, Hohnloser S, Hindricks G, Kirchhof P (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. doi:10.​1093/​eurheartj/​ehs253 PubMed
31.
Zurück zum Zitat Verma A, Jiang C, Betts T, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo C, Haverkamp W, Weerasooriya R, Albenque J, Nardi S, Menardi E, Novak P, Sanders P (2015) Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812–1822CrossRefPubMed Verma A, Jiang C, Betts T, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo C, Haverkamp W, Weerasooriya R, Albenque J, Nardi S, Menardi E, Novak P, Sanders P (2015) Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812–1822CrossRefPubMed
Metadaten
Titel
Catheter ablation of persistent atrial fibrillation
Long-term results of circumferential pulmonary vein ablation in combination with a linear lesion at the roof of the left atrium
verfasst von
Klaus Kettering, MD
Dag-Hau Yim
Caroline Albert
Felix Gramley, MD
Publikationsdatum
24.04.2017
Verlag
Springer Medizin
Erschienen in
Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 4/2017
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI
https://doi.org/10.1007/s00399-017-0499-x

Weitere Artikel der Ausgabe 4/2017

Herzschrittmachertherapie + Elektrophysiologie 4/2017 Zur Ausgabe

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.