Right side only catheter ablation for drug-refractory paroxysmal AF maintained sinus rhythm without medications in 5 of 18 patients and lowered atrial defibrillation thresholds (2.6 vs 1.7 J).
Observational (n=18)
Does right-side only catheter ablation improve sinus rhythm maintenance in patients with drug-refractory paroxysmal atrial fibrillation?
A right-side only catheter ablation approach for paroxysmal AF provides limited long-term success for maintaining sinus rhythm, though it may lower atrial defibrillation thresholds.
We report the long-term follow-up of a right side only catheter ablation approach for paroxysmal AF. Eighteen patients with AF refractory to drugs entered the study. Ablation was attempted in the right atrium only by creating linear lesions based on a specific design including from two to four linear lesions. Induction of AF was attempted before ablation and after placement of the lesions. A septal lesion was performed in nine patients. In ten patients atrial defibrillation thresholds (ADFTs) before ablation and following creation of the linear lesions were compared. After a mean follow-up of 22 +/- 11 months, seven patients had recurrence of AF, and another nine patients experienced atrial flutter or atrial tachycardia. Five patients remained in sinus rhythm without medications and four required the use of drugs. Three patients had sporadic AF and six were in chronic AF. The recurrence rate was similar in patients with and without the septal lesion. However, a cure with right side ablation appeared to be predicted by the presence of disorganized and earlier activity in the high right atrium and crista terminalis. Linear lesions in the right atrium were associated with a lower ADFT (pre 2.6 +/- 04 J vs post 1.7 +/- 0.6 J). In conclusion, in a small number of patients, control of AF can be obtained with a right side only approach. Certain activation patterns may identify patients suitable to this approach. No specific lesion pattern appeared more effective. Right atrial linear lesions resulted in lower ADFT.
Natale et al. (Tue,) conducted a observational in Paroxysmal atrial fibrillation (n=18). Right side only catheter ablation was evaluated on Recurrence of atrial fibrillation, flutter, or tachycardia. Right side only catheter ablation for drug-refractory paroxysmal AF maintained sinus rhythm without medications in 5 of 18 patients and lowered atrial defibrillation thresholds (2.6 vs 1.7 J).