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European Heart Journal Advance Access published online on July 8, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn302
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation

Sébastien Knecht*, Mélèze Hocini, Matthew Wright, Nicolas Lellouche, Mark D. O’Neill, Seiichiro Matsuo, Isabelle Nault, Vijay S. Chauhan, Kevin J. Makati, Michela Bevilacqua, Kang-Teng Lim, Frederic Sacher, Antoine Deplagne, Nicolas Derval, Pierre Bordachar, Pierre Jaïs, Jacques Clémenty and Michel Haïssaguerre

Service de Rythmologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux/Université Victor Segalen Bordeaux II, Bordeaux-Pessac, France

Received 28 February 2008; revised 9 May 2008; accepted 12 June 2008.

* Corresponding author. Tel: +33 5 57 65 64 71, Fax: +33 5 57 65 65 09, Email sebastien.knecht{at}chu-brugmann.be

Aims: This study evaluates the clinical outcome and incidence of left atrial (LA) macro re-entrant atrial tachycardia (AT) in patients in whom persistent atrial fibrillation (AF) terminated during catheter ablation without the need of roof and mitral lines.

Methods and results: Persistent AF was terminated by ablation in 154 of 180 consecutive patients. AF history was 60 months including 11 months of continuous AF. Patients were divided into two groups: those who had not required both LA linear lesions to terminate AF (group A, 85 patients), and those who had (group B, 69 patients). There was no difference in clinical and echocardiographic characteristics between both groups except for a shorter duration of continuous AF in group A (9 vs.12 months, respectively) (P = 0.03). After 28 months of follow-up, the incidence of LA macro re-entrant AT necessitating linear ablation was higher in group A (76%) compared with group B (33%) (P = 0.002). When complete linear block could not be achieved during the index procedure, the incidence of subsequent roof (P = 0.008) or mitral isthmus (P = 0.010) dependent macro re-entrant AT was higher.

Conclusion: Although persistent AF can be terminated by catheter ablation without linear lesions, the majority will require linear lesions for macro re-entrant AT.

Key Words: Atrial fibrillation • Linear lesions • Mitral isthmus line • Roof line • Substrate ablation • Atrial tachycardia • Macro re-entry


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