Catheter Ablation for Paroxysmal Atrial Fibrillation

TLDR

Segmental ostial catheter ablation (SOCA) to isolate pulmonary veins and left atrial catheter ablation (LACA) to encircle them are both potential treatments for paroxysmal atrial fibrillation. This study directly compares the efficacy of SOCA versus LACA in patients with symptomatic paroxysmal atrial fibrillation. In SOCA, ostial pulmonary‑vein potentials were targeted with a ring catheter, whereas LACA encircled the veins 1–2 cm from the ostia guided by electroanatomic mapping and added lines in the mitral isthmus and posterior left atrium, with comparable procedure and fluoroscopy times. At six months, 88 % of LACA patients and 67 % of SOCA patients were free of symptomatic atrial fibrillation off antiarrhythmic drugs (P = 0.02), with larger left atrial size and the SOCA technique independently predicting recurrence, and the only complication was left‑atrial flutter after LACA.

Abstract

Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared.Of 80 consecutive patients with symptomatic PAF (age, 52+/-10 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left- and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 156+/-45 and 50+/-17 minutes for SOCA and 149+/-33 and 39+/-12 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of symptomatic PAF when not taking antiarrhythmic drug therapy (P=0.02). Among the variables of age, sex, duration and frequency of PAF, ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size and the SOCA technique were independent predictors of recurrent PAF. The only complication was left atrial flutter in a patient who underwent LACA.In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA.