Guest guest Posted October 27, 2003 Report Share Posted October 27, 2003 Just got this through: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\ 4557355 & dopt=Abstract Circulation. 2003 Oct 13 Catheter Ablation for Paroxysmal Atrial Fibrillation. Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation. Oral H, Scharf C, Chugh A, Hall B, Cheung P, Good E, Veerareddy S, Pelosi F Jr, Morady F. Division of Cardiology, University of Michigan, Ann Arbor. BACKGROUND: Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared. METHODS AND RESULTS: Of 80 consecutive patients with symptomatic PAF (age, 52+/-10 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left- and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 156+/-45 and 50+/-17 minutes for SOCA and 149+/-33 and 39+/-12 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of symptomatic PAF when not taking antiarrhythmic drug therapy (P=0.02). Among the variables of age, sex, duration and frequency of PAF, ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size and the SOCA technique were independent predictors of recurrent PAF. The only complication was left atrial flutter in a patient who underwent LACA. CONCLUSIONS: In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA. PMID: 14557355 ------------------ I *still* don't really know what " segmental " means - anyone know any pictures that explain it properly? The above is Fred Morady's team's work - anyone know what Haissaguerre, Jais and co think? Best of health to all, Vicky " All truth goes through three stages: first it is ridiculed, then it is violently opposed, finally it is accepted as self evident. " - Schopenhauer --------------------------------------------------------------------------------\ ------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2003 Report Share Posted December 22, 2003 ablation lines also were created in the mitral isthmus and posterior left atrium. Dear Vicky, I haven't read the whole article by the Un. of Michigan group. But one problem with their study comparing Segmental vs. making circular lesions around the veins is that mitral isthmus and posterior left atrium lines were only made in the circular group. But the French Bordeaux group makes similar lines and uses Segmental Ablation. It isn't a fair comparison. Also, most centers doing Circumferfential ablations use circular catheters. The Morady group seems to be using a catheter to make circular lines which really isn't the same thing. It sounds to me that the Morady group procedure is very similar to what Pappone is doing in Italy. It looks like we're going to have to add more acronyms to the A-Fib vocabulary ( " SOCA " and " LACA " ). Just what we need, more confusing acronyms. A-FibFriendSteve Quote Link to comment Share on other sites More sharing options...
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