DOI QR코드

DOI QR Code

The Feasibility and Efficacy of a Large-Sized Lasso Catheter Combined With 3 Dimensional Mapping System for Catheter Ablation of Atrial Fibrillation

  • Jang, Sung-Won (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Shin, Woo-Seung (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Ji-Hoon (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Min-Seok (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Yun-Seok (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Oh, Yong-Seog (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Man-Young (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Rho, Tai-Ho (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • Published : 2011.08.30

Abstract

Background and Objectives: We aimed to investigate whether a large-sized Lasso catheter could increase the success rate of immediate complete pulmonary vein (PV) antral isolation and improve the outcome of catheter ablation in atrial fibrillation (AF) patients. Subjects and Methods: This study included 107 consecutive patients (67 males, mean age: 57.8${\pm}$9.7 years) who underwent PV mapping and ablation due to symptomatic drug-refractory AF. The first 43 patients underwent isolation of both ipsilateral PVs using the Carto-Merge 3 dimensional mapping system (group 1). The other 64 patients underwent isolation of both ipsilateral PVs using the same technique with a large-sized (a diameter of 30 to 35 mm) Lasso cathe-ter (group 2). When ipsilateral PVs did not show any potential after the initial circumferential ablation, we defined this as 'immediate complete antral isolation (ICAI)'. We compared the AF recurrence rate of both groups. Results: There was no sig-nificant difference of the clinical characteristics between group 1 and group 2. All the patients were followed-up for 1 year. The ICAI rate of group 1 and group 2 was significantly different (21% vs. 78%, p<0.001), and the AF recurrence rates of group 1 and group 2 were also different (34.9% vs. 18.8%, p=0.042). Using multiple logistic regression analysis, the use of a large-sized Lasso catheter was a significant predictive factor for preventing recurrence (odds ratio: 0.489, 95% confidence interval: 0.136-0.927). Conclusion: It is likely that a large-sized Lasso catheter plays an important role in achieving ICAI and in lowering the rate of AF recurrence.

Keywords

References

  1. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of at-rial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66. https://doi.org/10.1056/NEJM199809033391003
  2. Nam KB, Choi KJ, Park DW, Kim J, Rhee KS, Kim YH. Electrophy-siological characteristics of arterially-perfused canine pulmonary veins: role of the delayed afterdepolarization-induced triggered activity. Korean Circ J 2005;35:643-8. https://doi.org/10.4070/kcj.2005.35.9.643
  3. Jais P, Haissaguerre M, Shah DC, et al. A focal source of atrial fibrill-ation treated by discrete radiofrequency ablation. Circulation 1997;95:572-6. https://doi.org/10.1161/01.CIR.95.3.572
  4. Haissaguerre M, Jais P, Shah DC, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000;101:1409-17. https://doi.org/10.1161/01.CIR.101.12.1409
  5. Chen SA, Tai CT, Tsai CF, Hsieh MH, Ding YA, Chang MS. Radiofrequency catheter ablation of atrial fibrillation initiated by pulmonary vein ectopic beats. J Cardiovasc Electrophysiol 2000;11:218-27. https://doi.org/10.1111/j.1540-8167.2000.tb00324.x
  6. Oral H, Knight BP, Ozaydin M, et al. Segmental ostial ablation to iso-late the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights. Circulation 2002;106:1256-62. https://doi.org/10.1161/01.CIR.0000027821.55835.00
  7. Ouyang F, Bansch D, Ernst S, et al. Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation. Circulation 2004;110:2090-6. https://doi.org/10.1161/01.CIR.0000144459.37455.EE
  8. Ouyang F, Ernst S, Chun J, et al. Electrophysiological findings during ablation of persistent atrial fibrillation with electroanatomic mapp-ing and double Lasso catheter technique. Circulation 2005;112:3038-48. https://doi.org/10.1161/CIRCULATIONAHA.105.561183
  9. Dong J, Dickfeld T, Dalal D, et al. Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2006;17:459-66. https://doi.org/10.1111/j.1540-8167.2006.00425.x
  10. Hocini M, Jais P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation 2005;112: 3688-96. https://doi.org/10.1161/CIRCULATIONAHA.105.541052
  11. Jais P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation 2004;110:2996-3002. https://doi.org/10.1161/01.CIR.0000146917.75041.58
  12. Yamane T, Date T, Kanzaki Y, et al. Segmental pulmonary vein antrum isolation using the "large-size" lasso catheter in patients with atrial fi-brillation. Circ J 2007;71:753-60. https://doi.org/10.1253/circj.71.753
  13. Oral H, Scharf C, Chugh A, et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation 2003;108:2355-60. https://doi.org/10.1161/01.CIR.0000095796.45180.88
  14. Arentz T, Weber R, Burkle G, et al. Small or large isolation areas ar-ound the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation 2007;115:3057-63. https://doi.org/10.1161/CIRCULATIONAHA.107.690578
  15. Cheema A, Dong J, Dalal D, et al. Long-term safety and efficacy of cir-cumferential ablation with pulmonary vein isolation. J Cardiovasc Electrophysiol 2006;17:1080-5. https://doi.org/10.1111/j.1540-8167.2006.00569.x
  16. Ouyang F, Antz M, Ernst S, et al. 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 2005;111:127-35. https://doi.org/10.1161/01.CIR.0000151289.73085.36