J Adams

Ablation of focally induced atrial fibrillation: selective or extensive?

Introduction: Focally induced atrial fibrillation (AF) often is due to ectopic activity in the pulmonary veins (PV). Although initial approaches were aimed at ablating only the ectopic foci, more extensive ablation approaches have evolved that isolate all PVs empirically and/or create circumferential ablation lines in the left atrium (LA). These techniques last longer and may be associated with more risks. We retrospectively evaluated the outcome and risks of ablation for focally induced AF in a single‐center patient population.

Use of only a regular diagnostic His-bundle catheter for both fast and reproducible "para-Hisian pacing" and stable right ventricular pacing.

Pacing from the Diagnostic His‐Bundle Catheter. Introduction: Para‐Hisian pacing, i.e., pacing the anteroseptal right ventricle (RV) with or without direct capture of the His bundle (HB), allows the differentiation of VA conduction over the AV node from conduction over an accessory pathway. Classically, it is performed by maneuvering a separate pacing catheter around the HB catheter, which may be difficult and time‐consuming.

Long-term symptomatic benefit after radiofrequency catheter ablation for atrial flutter despite a high incidence of post-procedural atrial fibrillation.

Objective — A high proportion of patients develops atrial fibrillation (AF) after ablation for atrial flutter (AFL). Radiofrequency ablation for AFL therefore would only be useful if it leads to a better quality of life despite this high incidence of AF post-ablation. Methods — All patients who underwent AFL ablation in our centre before March 2002 (n = 203) were contacted by letter a median of 2.3 years after their ablation. Sixty-eight percent answered the questionnaire polling the perceived benefits of the procedure.The results were stratified according to the presenting arrhythmia before the ablation: only AFL, predominantly AFL, predominantly AF or class Ic-III AFL. Results — Despite a 60% incidence of AF, 84% considered the procedure to be beneficial during the 1st year and 77% during the 2nd year post-ablation. Patients with predominantly AF before the procedure showed significantly less overall improvement than the 3 other groups (50% and 33% after 1 year and 2 years, p< 0.01) and a smaller reduction in palpitations (50% and 29% after 1 year and 2 years, p< 0.01). The benefit of an ablation was also significantly less in patients who developed AF post-ablation than in patients who were completely arrhythmia free (75% versus 98% 1st year, 58% versus 91% 2nd year; p< 0.01); nevertheless 75% of these patients reported fewer palpitations and 56% tolerated symptoms better than before. Conclusions — Despite a high incidence of AF after AFL ablation, the majority of patients considered the intervention beneficial. Only in patients with predominantly AF before ablation the procedure does not seem beneficial.