Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia, but its therapy is still unsatisfactory. Catheter ablation techniques, consisting in linear lesions both in the right and in the left atrium, mimicking the surgical Maze procedure, have beem proposed to cure this arrhythmia. However such extensive ablation in the left atrium may be related to the risk of severe complication and therefore a more limited procedure should be advisable. Some experimental data on atrial mapping in animals and in humans suggest that the atria do not behave homogeneously during AF but that different regions simultaneously present different activation patterns. Therefore it is conceivable that not all the regions of the atria play the same role in the maintenance of the arrhythmia, suggesting that a more selective ablation, avoiding RF delivery in the left atrium, may be possible in some patients. In our experience in patients with idiopathic AF a catheter ablation procedure limited to the right atrium showed a success rate of 56% in the prevention of AF recurrences. Moreover patients with successful baltion showed a peculiar pattern of atrial activation characterised by a more irregular atrial activation in the septum than in the alteral right wall. while this was not observed in patients with unsuccessful ablation.ù Catheter ablation in the right atrium has been demonstrated to be effective in some patients with idiopathic AF and should be preferred to a procedure involving also the left atrium in order to reduce the risk of complication. An improvement in the electrophysiologic substrate of the atrial features during AF is important to better characterise the different types of AF and consequently the identification of the best ablation procedure.
Atrial fibrillation: catheter ablation in the right atrium. Why and when?
Kirchner, Michele
1998-01-01
Abstract
Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia, but its therapy is still unsatisfactory. Catheter ablation techniques, consisting in linear lesions both in the right and in the left atrium, mimicking the surgical Maze procedure, have beem proposed to cure this arrhythmia. However such extensive ablation in the left atrium may be related to the risk of severe complication and therefore a more limited procedure should be advisable. Some experimental data on atrial mapping in animals and in humans suggest that the atria do not behave homogeneously during AF but that different regions simultaneously present different activation patterns. Therefore it is conceivable that not all the regions of the atria play the same role in the maintenance of the arrhythmia, suggesting that a more selective ablation, avoiding RF delivery in the left atrium, may be possible in some patients. In our experience in patients with idiopathic AF a catheter ablation procedure limited to the right atrium showed a success rate of 56% in the prevention of AF recurrences. Moreover patients with successful baltion showed a peculiar pattern of atrial activation characterised by a more irregular atrial activation in the septum than in the alteral right wall. while this was not observed in patients with unsuccessful ablation.ù Catheter ablation in the right atrium has been demonstrated to be effective in some patients with idiopathic AF and should be preferred to a procedure involving also the left atrium in order to reduce the risk of complication. An improvement in the electrophysiologic substrate of the atrial features during AF is important to better characterise the different types of AF and consequently the identification of the best ablation procedure.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
