Modification of the substrate for maintenance of idiopathic human atrial fibrillation - Efficacy of radiofrequency ablation using nonfluoroscopic catheter guidance

Background-Catheter ablative techniques to modify the substrate to maintain atrial fibrillation (AF) require the creation of continuous radiofrequency current-induced ablation lines. This study was designed to assess the effi cacy and safety of nonfluoroscopic mapping in this setting. Methods and Results-A total of 45 consecutive patients with idiopathic AF w ere studied. The first 13 underwent ablation confined to the left atrium by creating a circular line isolating the pulmonary vein ostia and a second l ine connecting the former with the mitral annulus. Subsequently, 12 of thes e patients underwent a procedure confined to the right atrium (RA), where a ttempts were made to create an isthmus line between the inferior vena cava and the tricuspid annulus, an anterior Line connecting the tricuspid annulu s with the superior vena cava, and an intercaval line between the ostia of the inferior and superior venae cavae, In the last 32 patients, only the RA approach was performed. Technical difficulties prevented the creation of t he intended left atrial line pattern: all patients experienced recurrences. A 100% recurrence rate was also observed after subsequent RA ablation, des pite creation of a complete line pattern in 4 of 12 patients. Of the final 32 patients, AF recurred in 94%; a complete ablation line pattern had been achieved in 18 patients (56%), 16 of whom had recurrences. Conclusions-The electroanatomically-guided creation of extended radiofreque ncy current lesions is technically feasible only in the RA. However, proced ural success in the RA does not suppress recurrences of AF in the majority of patients.