Article

Journal of Interventional Cardiac Electrophysiology

, Volume 17, Issue 2, pp 103-109

First online:

Pulmonary vein isolation and linear lesions in atrial fibrillation ablation

  • Imran SheikhAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , David KrumAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , Ryan CooleyAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , Anwer DhalaAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , Zalmen BlanckAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , Atul BhatiaAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , Vikram NangiaAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , Masood AkhtarAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health
  • , Jasbir SraAffiliated withElectrophysiology Laboratories, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health Email author 

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Abstract

Background

Various strategies have been used for atrial fibrillation (AF) ablation. It is unclear whether adding linear lesions to pulmonary vein (PV) isolation has significant advantages.

Objectives

We assessed the clinical benefit of adding linear lesions in patients undergoing PV isolation for AF.

Methods

One hundred patients (63 male and 37 female; mean age of 59 ± 11 years) with documented paroxysmal AF were included in the study. Patients were randomized into two groups. The first group underwent PV isolation alone. The second group underwent PV isolation and had two linear lesions created; one line between the superior PVs, and a second line from the left inferior PV to the mitral valve annulus. Patients’ clinical progress after the ablation was evaluated and compared at 1, 3, and 9 months after their respective ablation procedures.

Results

The linear lesions group maintained sinus rhythm and had fewer symptoms than the lone PV isolation group (86 vs. 58%, respectively) (p < 0.05) at 1 month. At 9 months, when patients who reverted to AF underwent additional management to regain sinus rhythm (90 vs. 82%, respectively) (p = NS), there was no statistical difference between the groups regarding the use of antiarrhythmics, the need for electrical cardioversion, and subjective improvement.

Conclusion

The addition of linear lesions to PV isolation more effectively achieved sinus rhythm initially and fewer patients required additional management to maintain their rhythm when compared to patients who underwent lone PV isolation. However, at 9 months, the overall results were similar in both groups.

Keywords

Atrial fibrillation Ablation procedures Pulmonary vein isolation Linear lesions