Heart and Vessels

, Volume 30, Issue 5, pp 675–681 | Cite as

Efficacy and safety of novel epicardial circumferential left atrial ablation with pulmonary vein isolation in sustained atrial fibrillation

  • Zhaolei Jiang
  • Hang Yin
  • Yi He
  • Nan Ma
  • Min Tang
  • Hao Liu
  • Fangbao Ding
  • Ju Mei
Original Article
First Online:
Received:
Accepted:

Abstract

The aim of this study was to examine the efficacy and safety of this novel epicardial circumferential left atrial ablation (CLAA) with pulmonary vein isolation (PVI) in sustained atrial fibrillation (AF). Thirty domestic pigs were divided equally into 3 groups: AF without ablation (AF group), AF with PVI (PVI group), and AF with CLAA and PVI (CLAA + PVI group). AF was induced by rapid atrial pacing. After AF was induced, CLAA and PVI were performed for pigs in CLAA + PVI group, and PVI was performed for pigs in PVI group. AF vulnerability, AF duration, and histology were performed in all groups. All pigs developed sustained AF after 6.27 ± 0.69 weeks of rapid atrial pacing. All pigs successfully underwent isolated PVI or CLAA with PVI on the beating heart in PVI group or CLAA + PVI group. Isolated PVI terminated AF in 3 of 20 pigs (15 %), and CLAA with PVI terminated AF in 5 of 8 pigs (62.5 %, P = 0.022). Compared with AF group (10/10), the incidence of sustained AF by burst pacing was significantly decreased in PVI group (3/10, P = 0.003) or CLAA + PVI group (0/10, P < 0.001). There was no significant difference between PVI group and CLAA + PVI group (P = 0.211). AF duration was significantly decreased in CLAA + PVI group (734.70 ± 177.81 s, 95 % CI 607.51–861.89) compared with PVI group (1217.90 ± 444.10 s, 95 % CI 900.21–1535.59, P = 0.008). Also, AF duration was significantly decreased in PVI group (P = 0.003) or CLAA + PVI group (P < 0.001) in comparison with AF duration in AF group (average 1800 s). Epicardial CLAA could ablate the left atrial roof and posterior wall together safely and reliably. Compared with PVI alone, CLAA with PVI may be able to improve the rate of acute termination of persistent AF. It may be useful in selecting the best ablation approaches for patients with persistent AF.

Keywords

Atrial fibrillation Ablation Pulmonary vein isolation Epicardial Efficacy 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

We are grateful for the financial support from Shanghai Science and Technology Grant (No. 11441900200) (No. 13XD1403200). We thank Dr. Wei-Chung Tsai, Dr. Chunrong Bao, Dr. Jianbing Huang, Dr. Junwen Zhang for their help in the preparation of the manuscript.

Conflict of interest

There are no conflicts of interest to report.

References

  1. 1.
    American College of Cardiology Foundation, American Heart Association, European Society of Cardiology, Heart Rhythm Society, Wann LS, Curtis AB, Ellenbogen KA, Estes NA, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey J, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS (2013) Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation 127(18):1916–1926CrossRefGoogle Scholar
  2. 2.
    McManus DD, Rienstra M, Benjamin EJ (2012) An update on the prognosis of patients with atrial fibrillation. Circulation 126(10):e143–e146CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Anter E, Jessup M, Callans DJ (2009) Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation 119(18):2516–2525CrossRefPubMedGoogle Scholar
  4. 4.
    Cox JL, Schuessler RB, D’Agostino HJ, Stone CM, Chang BC, Cain ME, Corr PB, Boineau JP (1991) The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 101(4):569–583PubMedGoogle Scholar
  5. 5.
    Prasad SM, Maniar HS, Camillo CJ, Schuessler RB, Boineau JP, Sundt TM 3rd, Cox JL, Damiano RJ Jr (2003) The Cox Maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg 126(6):1822–1828CrossRefPubMedGoogle Scholar
  6. 6.
    Tilz RR, Chun KR, Schmidt B, Fuernkranz A, Wissner E, Koester I, Baensch D, Boczor S, Koektuerk B, Metzner A, Zerm T, Ernst S, Antz M, Kuck KH, Ouyang F (2010) Catheter ablation of long-standing persistent atrial fibrillation: a lesson from circumferential pulmonary vein isolation. J Cardiovasc Electrophysiol 21(10):1085–1093CrossRefPubMedGoogle Scholar
  7. 7.
    Chao TF, Tsao HM, Lin YJ, Tsai CF, Lin WS, Chang SL, Lo LW, Hu YF, Tuan TC, Suenari K, Li CH, Hartono B, Chang HY, Ambrose K, Wu TJ, Chen SA (2012) Clinical outcome of catheter ablation in patients with nonparoxysmal atrial fibrillation: results of 3-year follow-up. Circ Arrhythm Electrophysiol 5(3):514–520CrossRefPubMedGoogle Scholar
  8. 8.
    Latchamsetty R, Morady F (2013) Long-term benefits following catheter ablation of atrial fibrillation. Circ J 77(5):1091–1096CrossRefPubMedGoogle Scholar
  9. 9.
    Hori Y, Nakahara S, Kamijima T, Tsukada N, Hayashi A, Kobayashi S, Sakai Y, Taguchi I (2014) Influence of Left Atrium Anatomical Contact Area in Persistent Atrial Fibrillation. Circ J 78(8):1851–1857CrossRefPubMedGoogle Scholar
  10. 10.
    Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, Scharf C, Lai SW, Greenstein R, Pelosi F Jr, Strickberger SA, Morady F (2002) Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 105(9):1077–1081CrossRefPubMedGoogle Scholar
  11. 11.
    Wolf RK, Schneeberger EW, Osterday R, Miller D, Merrill W, Flege JB Jr, Gillinov AM (2005) Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg 130(3):797–802CrossRefPubMedGoogle Scholar
  12. 12.
    Edgerton JR, Jackman WM, Mack MJ (2009) A new epicardial lesion set for minimal access left atrial maze: the Dallas lesion set. Ann Thorac Surg 88(5):1655–1657CrossRefPubMedGoogle Scholar
  13. 13.
    Edgerton JR, Jackman WM, Mahoney C, Mack MJ (2009) Totally thoracoscopic surgical ablation of persistent AF and long-standing persistent atrial fibrillation using the “Dallas” lesion set. Heart Rhythm 6(12 Suppl):S64–S70CrossRefPubMedGoogle Scholar
  14. 14.
    Betts TR, Jones M, Wong KC, Qureshi N, Rajappan K, Bashir Y (2013) Feasibility of mitral isthmus and left atrial roof linear lesions using an 8 mm tip cryoablation catheter. J Cardiovasc Electrophysiol 24(7):775–780CrossRefPubMedGoogle Scholar
  15. 15.
    Jaïs P, Hocini M, Hsu LF, Sanders P, Scavee C, Weerasooriya R, Macle L, Raybaud F, Garrigue S, Shah DC, Le Metayer P, Clémenty J, Haïssaguerre M (2004) Technique and results of linear ablation at the mitral isthmus. Circulation 110(19):2996–3002CrossRefPubMedGoogle Scholar
  16. 16.
    Hocini M, Jaïs P, Sanders P, Takahashi Y, Rotter M, Rostock T, Hsu LF, Sacher F, Reuter S, Clémenty J, Haïssaguerre M (2005) Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation 112(24):3688–3696CrossRefPubMedGoogle Scholar
  17. 17.
    Jiang Z, Ma N, Tang M, Liu H, Ding F, Yin H, Mei J (2014) Effect of novel modified bipolar radiofrequency ablation for preoperative atrial fibrillation combined with off-pump coronary artery bypass grafting surgery. Heart Vessel. doi: 10.1007/s00380-014-0519-2 Google Scholar
  18. 18.
    Mei J, Ma N, Ding F, Chen Y, Jiang Z, Hu F, Xiao H (2014) Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg 147(1):242–246CrossRefPubMedGoogle Scholar
  19. 19.
    Ma N, Ding F, Jiang Z, Chen Y, Hu F, Mei J (2012) Totally endoscopic ablation of left atrium via left chest for lone atrial fibrillation. Innovations (Phila) 7(5):382–384CrossRefGoogle Scholar
  20. 20.
    Michaud GF, John R (2011) Percutaneous pulmonary vein isolation for atrial fibrillation ablation. Circulation 123(20):e596–e601CrossRefPubMedGoogle Scholar
  21. 21.
    Gill JS (2004) How to perform pulmonary vein isolation. Europace 6(2):83–91CrossRefPubMedGoogle Scholar
  22. 22.
    Wyse DG (2013) A critical perspective on the role of catheter ablation in management of atrial fibrillation. Can J Cardiol 29(10):1150–1157CrossRefPubMedGoogle Scholar
  23. 23.
    Kalifa J, Tanaka K, Zaitsev AV, Warren M, Vaidyanathan R, Auerbach D, Pandit S, Vikstrom KL, Ploutz-Snyder R, Talkachou A, Atienza F, Guiraudon G, Jalife J, Berenfeld O (2006) Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation 113(5):626–633CrossRefPubMedGoogle Scholar
  24. 24.
    Sternik L, Schaff HV, Luria D, Glikson M, Kogan A, Malachy A, First M, Raanani E (2011) Left atrial ablation for atrial fibrillation: creating the “box lesion” with a bipolar radiofrequency device. Tex Heart Inst J 38(2):127–131PubMedCentralPubMedGoogle Scholar
  25. 25.
    Maeda S, Iesaka Y, Uno K, Otomo K, Nagata Y, Suzuki K, Hachiya H, Goya M, Takahashi A, Fujiwara H, Hiraoka M, Isobe M (2012) Complex anatomy surrounding the left atrial posterior wall: analysis with 3D computed tomography. Heart Vessel 27(1):58–64CrossRefGoogle Scholar
  26. 26.
    Tokuda M, Yamane T, Tokutake K, Yokoyama K, Hioki M, Narui R, Tanigawa SI, Yamashita S, Inada K, Matsuo S, Yoshimura M (2014) Catheter ablation of persistent atrial fibrillation in a patient with cor triatriatum sinister demonstrating a total common trunk of the pulmonary vein. Heart Vessel. doi: 10.1007/s00380-014-0580-x Google Scholar
  27. 27.
    Wilber DJ (2012) Fibroblasts, focal triggers, and persistent atrial fibrillation: is there a connection? Circ Arrhythm Electrophysiol 5(2):249–251CrossRefPubMedGoogle Scholar
  28. 28.
    Inoue K, Kurotobi T, Kimura R, Toyoshima Y, Itoh N, Masuda M, Higuchi Y, Date M, Koyama Y, Okamura A, Iwakura K, Fujii K (2012) Trigger-based mechanism of the persistence of atrial fibrillation and its impact on the efficacy of catheter ablation. Circ Arrhythm Electrophysiol 5(2):295–301CrossRefPubMedGoogle Scholar
  29. 29.
    Nishida K, Sarrazin JF, Fujiki A, Oral H, Inoue H, Morady F, Nattel S (2010) Roles of the left atrial roof and pulmonary veins in the anatomic substrate for persistent atrial fibrillation and ablation in a canine model. J Am Coll Cardiol 56(21):1728–1736CrossRefPubMedGoogle Scholar
  30. 30.
    Mounsey JP (2010) Left atrial roof ablation is more important than pulmonary vein isolation in terminating persistent atrial fibrillation in a canine model should we perform a left atrial roof line in all atrial fibrillation ablations? J Am Coll Cardiol 56(21):1737–1739CrossRefPubMedGoogle Scholar
  31. 31.
    van Brakel TJ, Bolotin G, Nifong LW, Dekker AL, Allessie MA, Chitwood WR Jr, Maessen JG (2005) Robot-assisted epicardial ablation of the pulmonary veins: is a completed isolation necessary? Eur Heart J 26(13):1321–1326CrossRefPubMedGoogle Scholar
  32. 32.
    Gelsomino S, Corradi D, Lorusso R, Parise O, Callegari S, Macchi E, Maessen J, La Meir M (2013) Anatomical basis of minimally invasive epicardial ablation of atrial fibrillation. Eur J Cardiothorac Surg 43(4):673–682CrossRefPubMedGoogle Scholar
  33. 33.
    Thomas SP, Guy DJ, Boyd AC, Eipper VE, Ross DL (2003) Chard RB (2003) Comparison of epicardial and endocardial linear ablation using handheld probes. Ann Thorac Surg 75(2):543–548CrossRefPubMedGoogle Scholar
  34. 34.
    Suenari K, Nakano Y, Hirai Y, Ogi H, Oda N, Makita Y, Ueda S, Kajihara K, Tokuyama T, Motoda C, Fujiwara M, Chayama K, Kihara Y (2013) Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography. Heart Vessel 28(3):360–368CrossRefGoogle Scholar
  35. 35.
    Wakasa S, Kubota S, Shingu Y, Kato H, Ooka T, Tachibana T, Matsui Y (2014) Histological assessment of transmurality after repeated radiofrequency ablation of the left atrial wall. Gen Thorac Cardiovasc Surg 62(7):428–433CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Zhaolei Jiang
    • 1
  • Hang Yin
    • 1
  • Yi He
    • 1
  • Nan Ma
    • 1
  • Min Tang
    • 1
  • Hao Liu
    • 1
  • Fangbao Ding
    • 1
  • Ju Mei
    • 1
  1. 1.Department of Cardiothoracic Surgery, Xinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina

Personalised recommendations