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Completion of Mitral Isthmus Ablation Using a Steerable Sheath: Prospective Randomized Comparison With a Nonsteerable Sheath
Author(s) -
MATSUO SEIICHIRO,
YAMANE TEIICHI,
DATE TARO,
HIOKI MIKA,
NARUI RYOHSUKE,
ITO KEIICHI,
TANIGAWA SHINICHI,
NAKANE TOKIKO,
YAMASHITA SEIGO,
TOKUDA MICHIFUMI,
INADA KEIICHI,
NOJIRI AYUMI,
KAWAI MAKOTO,
SUGIMOTO KENICHI,
YOSHIMURA MICHIHIRO
Publication year - 2011
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2011.02112.x
Subject(s) - medicine , ablation , atrial fibrillation , catheter ablation , coronary sinus , cardiology , atrial tachycardia , radiofrequency ablation , randomized controlled trial , surgery
Completion of Mitral Isthmus Ablation. Background : Although mitral isthmus (MI) ablation in atrial fibrillation (AF) patients has been shown to be an effective ablative strategy, the establishment of the bidirectional conduction block of the MI is technically challenging. We investigated the usefulness of a steerable sheath for MI ablation in patients with persistent AF and its impact on the clinical outcome of persistent AF ablation.Methods : A total of 80 consecutive patients undergoing MI ablation were randomized to 1 of the following 2 groups: group S (using a steerable long sheath) or group NS (using a nonsteerable long sheath). MI ablation was performed by using an open‐irrigated ablation catheter with the guidance of a 3‐dimensional mapping system. The endpoint of the MI ablation was the achievement of a bidirectional block.Results : Bidirectional block through the MI was achieved in 87.5% (70/80) of patients with 14.0 ± 6.7 minutes of radiofrequency application. The bidirectional block was more frequently achieved in patients in group S compared to group NS (97.5% (39/40) vs 77.5% (31/40), P = 0.02). Additionally, epicardial ablation within the coronary sinus was less frequently required in group S compared to group NS (12.5% (5/40) vs 72.5% (29/40), P < 0.0001). Atrial tachycardia after the procedure more frequently occurred in the patients in whom MI block had not been achieved during the initial procedure (40.0% (4/10) vs 10.0% (7/70), P = 0.04).Conclusions : The MI block could be achieved in the majority of patients by using a steerable sheath. An incomplete MI block increased the risk of AT following persistent AF ablation. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1331‐1338, December 2011)