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The old segmental chestnut

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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

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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

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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

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