Catheter ablation approach on the right side only for paroxysmal atrial fibrillation therapy: long-term results

We report the long-term follow-up of a right side only catheter ablation approach for paroxysmal AF. Eighteen patients with AF refractory to drugs entered the study. Ablation was attempted in the right atrium only by creating linear lesions based on a specific design including from two to four linear lesions. Induction of AF was attempted before ablation and after placement of the lesions. A septal lesion was performed in nine patients. In ten patients atrial defibrillation thresholds (ADFTs) before ablation and following creation of the linear lesions were compared. After a mean follow-up of 22 +/- 11 months, seven patients had recurrence of AF, and another nine patients experienced atrial flutter or atrial tachycardia. Five patients remained in sinus rhythm without medications and four required the use of drugs. Three patients had sporadic AF and six were in chronic AF. The recurrence rate was similar in patients with and without the septal lesion. However, a cure with right side ablation appeared to be predicted by the presence of disorganized and earlier activity in the high right atrium and crista terminalis. Linear lesions in the right atrium were associated with a lower ADFT (pre 2.6 +/- 04 J vs post 1.7 +/- 0.6 J). In conclusion, in a small number of patients, control of AF can be obtained with a right side only approach. Certain activation patterns may identify patients suitable to this approach. No specific lesion pattern appeared more effective. Right atrial linear lesions resulted in lower ADFT.

Tridimensional mapping: guided modification of the sinus node

Radiofrequency (RF) catheter modification of the sinus node appears to be a promising therapeutic modality for the treatment of inappropriate sinus tachycardia. Modification, as opposed to total obliteration, of the atrial pacemaker requires precise localization of the sinus node. This has been successfully achieved with a multicatheter approach guided by intracardiac echocardiography. This article describes the first clinical use of a tridimensional nonfluoroscopic mapping system to guide successful RF modification of the sinus node in two cases of inappropriate sinus tachycardia. This system simplifies the current approach and greatly reduces the fluoroscopy time.

Ablation of right and left ectopic atrial tachycardias using a three-dimensional nonfluoroscopic mapping system

We report our experience with mapping and ablation of right and left atrial tachycardia using a 3-dimensional nonfluoroscopic mapping system. Twenty-nine ectopic atrial tachycardias were successfully ablated. This novel mapping system has the potential to increase a successful cure of this arrhythmia by catheter ablation.