Left atrial posterior wall isolation does not improve the outcome of circumferential pulmonary vein ablation for atrial fibrillation: a prospective randomized study

David Tamborero, Lluís Mont, Antonio Berruezo, Maria Matiello, Begoña Benito, Marta Sitges, Barbara Vidal, Teresa M de Caralt, Rosario J Perea, Radu Vatasescu, Josep Brugada
Circulation. Arrhythmia and Electrophysiology 2009, 2 (1): 35-40

BACKGROUND: Ablation of the pulmonary veins (PVs) for atrial fibrillation treatment is often combined with linear radiofrequency lesions along the left atrium (LA) to improve the success rate. The study was designed to assess the contribution of LA posterior wall isolation to the outcome of circumferential pulmonary vein ablation (CPVA).

METHODS AND RESULTS: CPVA consisted of continuous radiofrequency lesions encircling both ipsilateral PVs plus an ablation line along the mitral isthmus. Patients were then randomized into 2 groups. In the first group, superior PVs were connected by linear lesions along the LA roof (CPVA-1 group). In the second group, the LA posterior wall was isolated by adding a second line connecting the inferior aspect of the 2 inferior PVs (CPVA-2 group). The study included 120 patients (53+/-11 years, 77% male, 60% paroxysmal atrial fibrillation, LA of 41.3+/-5.4 mm, 46% with hypertension, and 22% with structural heart disease). After a single ablation procedure and a mean follow-up of 10+/-4 months, 24 (40%) patients of the CPVA-1 group had atrial fibrillation recurrences and 3 (5%) had new-onset LA flutter. In the CPVA-2 group, recurrences were due to atrial fibrillation episodes in 23 patients (38%) and LA flutter in 4 (7%). Freedom from arrhythmia recurrences was not statistically different in the CPVA-1 group as compared with the CPVA-2 group (log rank P=0.943).

CONCLUSIONS: Isolation of the LA posterior wall did not increase the success rate of CPVA.

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