RT-81
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Atrial fibrillation: catheter
ablation in the right atrium. Why and when?
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Fiorenzo Gaita, Riccardo
Riccardi, Marco Scaglione, Leonardo Calo, Renzo Antolini*, Filippo Lamberti, Elena
Richiardi, Lucia Garberoglio, Michele Kirckhner*.
Department of Cardiology, Ospedale Civile di Asti,
*Department of Physics, University of Trento, Italy
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Abstract
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Atrial fibrillation (AF) is the most frequent
supraventricular arrhythmia, but its therapy is still unsatisfactory. Catheter ablation
techniques, consisting in linear lesions both in the right and in the left atrium,
mimicking the surgical Maze procedure, have been proposed to cure this arrhythmia. However
such extensive ablation in the left atrium may be related to the risk of severe
complication and therefore a more limited procedure should be advisable.
Some experimental data on atrial mapping in animals and in humans suggest that the
atria do not behave homogeneously during AF but that different regions simultaneously
present different activation patterns. Therefore it is conceivable that not all the
regions of the atria play the same role in the maintenance of the arrhythmia, suggesting
that a more selective ablation, avoiding RF delivery in the left atrium, may be possible
in some patients.
In our experience in patients with idiopathic AF a catheter ablation procedure limited
to the right atrium showed a success rate of 56% in the prevention of AF recurrences.
Moreover patients with successful ablation showed a peculiar pattern of atrial activation
characterised by a more irregular atrial activation in the septum than in the lateral
right wall, while this was not observed in patients with unsuccessful ablation.
Catheter ablation in the right atrium has been demonstrated to be effective in some
patients with idiopathic AF and should be preferred to a procedure involving also the left
atrium in order to reduce the risk of complication. An improvement in the
electrophysiologic substrate of the atrial features during AF is important to better
characterise the different types of AF and consequently the identification of the best
ablation procedure.
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Key Words
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Atrial fibrillation
catheter ablation in right atrium, atrial mapping, atrial activation pattern, OA
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