C. Pratola

Radiofrequency Ablation of Atrial Fibrillation Is the Persistence of All Intraprocedural Targets Necessary for Long-Term Maintenance of Sinus Rhythm?

Background— Several approaches have been developed for radiofrequency catheter ablation of atrial fibrillation, but the correct intraprocedural end point is still under debate, and few data exist about the destiny of ablation lesions over time. The aim of the present study was to evaluate the long-term maintenance of intraprocedural end points of ablation procedures. Methods and Results— Inclusion criteria were (1) a previous ablation procedure of pulmonary vein (PV) encircling performed for drug-refractory persistent atrial fibrillation; (2) a “complete” intraprocedural end point, which consisted of voltage abatement inside the lesions, PV disconnection, and exit-block pacing from inside the lesions, attained in all PVs; and (3) stable sinus rhythm documented during a minimum follow-up of 2.5 years after the procedure. Twenty volunteers were selected (12 males, mean age 59±7 years) and underwent a repeat electrophysiological study. After a follow-up of 36.4±4.7 months, complete voltage abatement was maintained around 32 PVs (40.0%), PV disconnection persisted in 12 (37.5%) of the previously isolated PVs, and exit block was present in 39 PVs (48.7%). Ten patients who underwent a redo ablation procedure because of recurrences of atrial fibrillation were used as the control group. Differences in intraprocedural end-point maintenance between the 2 groups were not statistically significant. Conclusions— Common intraprocedural end points such as voltage abatement, PV disconnection, and exit block persist only in a limited number of patients, even when the outcome is favorable during follow-up. Further investigation will be required to determine whether such data will have implications for ablation strategies.

8. Different Mapping Systems and Approaches for Ablation of Atrial Fibrillation8.1 A ‘Complete’ Mapping System for Atrial Fibrillation Ablation

Radiofrequency ablation is an established therapeutic option for drug resistant atrial fibrillation. It is also becoming clear that it is necessary to use different approaches in different clinical situations, and often we have to adapt the technique to the patient characteristics. The electrophysiological approach can be performed with a multipolar pulmonary vein catheter with or without a mapping system whereas the anatomical approach requires a mapping system, for linear lesion creation and block confirmation. The ENSITE System (St.Jude Medical) recently acquired in our EP Lab is a “complete” system. It can be used as a contact mapping system for electroanatomical approach, and for activation map creation; it can be also used as a non contact system for fast linear lesion validation, identification and abolition of lesion gaps. The possibility of obtaining immediate non contact activation maps is a great advantage to reach higher success rates and to reduce procedural times. In Ferrara Ep lab we select the procedure on the target (trigger or atrial substrate) and thanks to flexibility of the Ensite system we can choose the best approach.

A ‘Complete’ Mapping System for Atrial Fibrillation Ablation

Radiofrequency ablation is an established therapeutic option for drug resistant atrial fibrillation. It is also becoming clear that it is necessary to use different approaches in different clinical situations, and often we have to adapt the technique to the patient characteristics. The electrophysiological approach can be performed with a multipolar pulmonary vein catheter with or without a mapping system whereas the anatomical approach requires a mapping system, for linear lesion creation and block confirmation. The ENSITE System (St.Jude Medical) recently acquired in our EP Lab is a “complete” system. It can be used as a contact mapping system for electroanatomical approach, and for activation map creation; it can be also used as a non contact system for fast linear lesion validation, identification and abolition of lesion gaps. The possibility of obtaining immediate non contact activation maps is a great advantage to reach higher success rates and to reduce procedural times. In Ferrara Ep lab we select the procedure on the target (trigger or atrial substrate) and thanks to flexibility of the Ensite system we can choose the best approach.

8. Different Mapping Systems and Approaches for Ablation of Atrial Fibrillation

Radiofrequency ablation is an established therapeutic option for drug resistant atrial fibrillation. It is also becoming clear that it is necessary to use different approaches in different clinical situations, and often we have to adapt the technique to the patient characteristics. The electrophysiological approach can be performed with a multipolar pulmonary vein catheter with or without a mapping system whereas the anatomical approach requires a mapping system, for linear lesion creation and block confirmation. The ENSITE System (St.Jude Medical) recently acquired in our EP Lab is a “complete” system. It can be used as a contact mapping system for electroanatomical approach, and for activation map creation; it can be also used as a non contact system for fast linear lesion validation, identification and abolition of lesion gaps. The possibility of obtaining immediate non contact activation maps is a great advantage to reach higher success rates and to reduce procedural times. In Ferrara Ep lab we select the procedure on the target (trigger or atrial substrate) and thanks to flexibility of the Ensite system we can choose the best approach.