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European Heart Journal Advance Access originally published online on July 13, 2005
European Heart Journal 2005 26(16):1687-1688; doi:10.1093/eurheartj/ehi367
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Towards a unified strategy for atrial fibrillation ablation?

Carlo Pappone

Department of Cardiology
Electrophysiology and Cardiac Pacing Unit
San Raffaele University Hospital
Milan 20132
Italy
E-mail address: carlo.pappone{at}hsr.it

Vincenzo Santinelli

Department of Cardiology
Electrophysiology and Cardiac Pacing Unit
San Raffaele University Hospital
Milan 20132
Italy

We read with great interest the recent editorial by Cappato1 in the European Heart Journal. In the last few years, most electrophysiological groups, including the pioneering group of Bordeaux, progressively and substantially changed their initial strategy of atrial fibrillation (AF) catheter ablation from focal or pulmonary vein isolation to more extensive lesions, aiming for a better success rate and lowering risks. We started performing circumferential pulmonary vein ablation (CPVA) simultaneously to the first approach described by the Bordeaux group and have not substantially changed CPVA technique overtime mainly because of the initial high success rates and minimal risks obtained in patients with both paroxysmal and chronic AF. Additional lines were added to avoid iatrogenic left atrial tachycardia from January 2002 and the final data on 580 patients have been recently published in Circulation.2 As you can see, this is the evolution of the CPVA approach and everybody knows, with a few exceptions perhaps, the results of our experience. Cappato commented on the occurrence of left atrial flutter as being a rather common adverse event after CPVA and thus a limiting factor of this technique. This is not now scientifically accurate. Unfortunately and surprisingly enough, Cappato has not reported in his editorial the aforementioned randomized study addressing this important and specific issue.2 The CPVA approach using additional lines in the posterior wall and mitral isthmus, which is from 2002 the current technique, has an incidence of left atrial tachycardia of only 3.9% when compared with 10% with CPVA alone.

We strongly believe that the two initial different strategies of the two pioneering groups on AF catheter ablation have now quite similar success rates and go towards a unified strategy, that is the CPVA approach.

References

  1. Cappato R. Towards more effective techniques for catheter ablation of atrial fibrillation: to aim for electrical disconnection of pulmonary veins or not? Eur Heart J 2005;26:627–630.[Free Full Text]
  2. Pappone C, Manguso F, Vicedomini G, Gugliotta F, Santinelli O, Ferro A, Gulletta S, Sala S, Sora N, Paglino G, Augello G, Agricola E, Zangrillo A, Alfieri O, Santinelli V. Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation. A prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach. Circulation 2004;110:3036–3042.[Abstract/Free Full Text]

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Home page
 Eur Heart J SupplHome page
C. Pappone and V. Santinelli
Non-fluoroscopic mapping as a guide for atrial ablation: current status and expectations for the future
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I36 - I47.
[Abstract] [Full Text] [PDF]

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