European Heart Journal Advance Access originally published online on March 6, 2007
European Heart Journal 2007 28(15):1862-1871; doi:10.1093/eurheartj/ehl548
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Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome
Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux-II, Bordeaux, France
Received 25 August 2006; revised 29 December 2006; accepted 25 January 2007; online publish-ahead-of-print 6 March 2007.
* Corresponding author: Prashanthan Sanders, Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital, Level 5, Mc Ewin Building, Adelaide, SA 5000, Australia. Tel: +61 8 8222 2723; fax: +61 8 8222 2722. E-mail address: prash.sanders{at}adelaide.edu.au
Aims: To evaluate the contribution of the posterior left atrium (LA) to chronic atrial fibrillation (AF).
Methods and results: Twenty-seven patients with chronic-AF were studied. After pulmonary vein (PV) isolation, the posterior-LA was isolated by ablation joining the right- and left-PVs using an irrigated-tip catheter. Isolation was demonstrated by absent/dissociated posterior-LA activity and the inability to pace the region. Ablation impact was determined by the effect on cycle length (CL) and AF termination. Posterior-LA isolation was achieved using 35 ± 12 min of radiofrequency with total fluoroscopic and procedural durations of 64 ± 16 and 199 ± 46 min, resulting in abolition of electrograms (n = 21) or autonomous activity (n = 6; CL 820 ± 343 ms). AFCL increased from 156 ± 28 ms to 162 ± 27 ms with PV-isolation and to 175 ± 32 ms by posterior-LA exclusion (P < 0.0001). AF persisted in all after PV-isolation and terminated in 5 (19%) during posterior-LA-isolation. After 10 ± 6 months, 12 patients developed atrial tachycardia (four) or AF (eight); four underwent repeat posterior-LA-isolation, while the others required additional ablation/antiarrhythmics. After 21 ± 5 months, 17 (63%) were in sinus rhythm following posterior-LA-isolation.
Conclusion: This study demonstrates the feasibility of complete posterior-LA exclusion by catheter ablation. This strategy results in maintenance of sinus rhythm in 63% at 
2 years follow-up.
Key Words: Atrial fibrillation • Arrhythmia • Ablation • Electrophysiology
Previous Presentation: Presented in part at the Heart Rhythm Society's 26th Annual Scientific Sessions, New Orleans, May 2005 and published in abstract form (Heart Rhythm 2005;2:S228–S229).
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