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Updated: Aug 14, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination
Michel Haïssaguerre1, Prashanthan Sanders, Mélèze Hocini
1Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France. jacques.clementy@pu.u-bordeaux2.fr
Insights
Catheter ablation successfully terminated persistent atrial fibrillation (AF) in 87% of patients. Targeting specific left atrial regions, including the pulmonary veins, significantly impacted AF cycle length and conversion to sinus rhythm.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Persistent atrial fibrillation (AF) maintenance mechanisms are not fully understood.
- Identifying key atrial regions contributing to AF is crucial for effective treatment.
Purpose of the Study:
- To investigate the relative contributions of different atrial regions to persistent AF maintenance.
- To evaluate the efficacy of targeted catheter ablation in terminating persistent AF.
Main Methods:
- Sixty patients with persistent AF underwent catheter ablation in a randomized sequence targeting various left atrial (LA) regions, pulmonary veins (PVs), and other thoracic veins.
- Ablation strategies included isolation of PVs, atrial tissue ablation guided by activation mapping, and linear ablation if sinus rhythm was not achieved.
- The impact of ablation was assessed by changes in fibrillatory cycle length in the coronary sinus and appendages, alongside activation mapping and entrainment for tachycardia characterization.
Main Results:
- AF terminated in 87% of patients, either directly to sinus rhythm or via ablation of intermediate atrial tachycardias.
- Ablation at the anterior LA, coronary sinus, and PV-LA junction showed the greatest prolongation of AF cycle length.
- Focal atrial tachycardias (38) originated from these key sites, while macroreentrant tachycardias (49) involved the mitral isthmus or LA roof.
Conclusions:
- Catheter ablation is effective in terminating persistent AF in a majority of patients (87%).
- Structures adjacent to the left atrium, including the left atrial appendage, coronary sinus, and PVs, significantly influence AF cycle length and tachycardia termination.
- Targeted ablation of these regions is key for successful AF management.
Background:
The relative contributions of different atrial regions to the maintenance of persistent atrial fibrillation (AF) are not known.
Methods:
Sixty patients (53 +/- 9 years) undergoing catheter ablation of persistent AF (17 +/- 27 months) were studied. Ablation was performed in a randomized sequence at different left atrial (LA) regions and comprised isolation of the pulmonary veins (PV), isolation of other thoracic veins, and atrial tissue ablation targeting all regions with rapid or heterogeneous activation or guided by activation mapping. Finally, linear ablation at the roof and mitral isthmus was performed if sinus rhythm was not restored after addressing the above-mentioned areas. The impact of ablation was evaluated by the effect on the fibrillatory cycle length in the coronary sinus and appendages at each step. Activation mapping and entrainment maneuvers were used to define the mechanisms and locations of intermediate focal or macroreentrant atrial tachycardias.
Results:
AF terminated in 52 patients (87%), directly to sinus rhythm in 7 or via the ablation of 1-6 intermediate atrial tachycardias (total 87) in 45 patients. This conversion was preceded by prolongation of fibrillatory cycle length by 39 +/- 9 msec, with the greatest magnitude occurring during ablation at the anterior LA, coronary sinus and PV-LA junction. Thirty-eight atrial tachycardias were focal (originating dominantly from these same sites), while 49 were macroreentrant (involving the mitral or cavotricuspid isthmus or LA roof). Patients without AF termination displayed shorter fibrillatory cycles at baseline: 130 +/- 14 vs 156 +/- 23 msec; P = 0.002.
Conclusion:
Termination of persistent AF can be achieved in 87% of patients by catheter ablation. Ablation of the structures annexed to the left atrium-the left atrial appendage, coronary sinus, and PVs-have the greatest impact on the prolongation of AF cycle length, the conversion of AF to atrial tachycardia, and the termination of focal atrial tachycardias.
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