Rhythm outcome after circular plus linear left atrial lesions for treatment of atrial fibrillation by the means of serial continuous 7-day-ECGs

Background: Success rates after left atrial ablation for curative treatment of atrial fibrillation (AF) depend on the mode of follow-up, i.e. symptom based, 24-h-Holter ECG or longer ECG recordings. The aim of this study was to report the rhythm outcome after circular plus linear left atrial lesions for treatment of highly symptomatic AF by the means of serial continuous 7-day-ECGs in a large patient population. Methods and Results: In 213 patients (pts) with paroxysmal (n 163) and persistent (n 50) AF, radiofrequency energy induced circular plus linear lesions were combined and placed around the left and right pulmonary veins (PV), respectively, between the two circles and from the left circle to the mitral annulus using the electroanatomic mapping system. The first 100 procedures were done using a 8-mm tip ablation catheter, thereafter a irrigated tip ablation catheter was used. Follow-up was done using serial continuous 7-day-ECGs and more than 115000 h of ECG recordings were analyzed. Complete freedom from AF directly after the ablation measured 29% in pts with paroxysmal AF and 22% in pts with persistent AF, 58% and 56% after 3 months, 54% and 52% after 6 months, and 64% and 38% after 12 months, respectively. Fifty-five percent of pts free from AF after 12 months had no antiarrhythmic drugs therapy (class Ic and/or III). Freedom from AF did not differ whether 8mm or irrigated tip catheters were used. In pts with AF recurrences, mean time spend in AF/7-day-ECG decreased significantly over time: 67 h before ablation, 30 h after ablation and 16 h after 12 months, respectively (p 0.0001), whereas the number of AF episodes/7-day-ECG remained unchanged: 7 episodes before ablation, 13 episodes after ablation, and 9 episodes after 12 months, respectively (p ns). Conclusions: The results obtained by serial 7-day-ECGs over time in pts with highly symptomatic AF applying the technique of placement of circular plus linear left atrial lesions show better long-term freedom from AF in pts with former paroxysmal AF than in those with former persistent AF. Continuous 7-day-ECG was helpful to detect relatively rare and short AF episodes.