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A new system for catheter ablation of atrial fibrillation

      Abstract

      Increased attention is now being focused on developing new technologies to cure atrial fibrillation using catheter ablation techniques. The performance of a MAZE-type procedure using standard catheter ablation technologies is arduous and is associated with an unacceptable risk of complications. The Guidant Heart Rhythm Technologies Linear Ablation System was developed to create long transmural linear lesions. Unique features of this system include the availability of different preshaped multi-electrode steerable ablation catheters, the use of phased radiofrequency (RF) energy, and the control of RF output by varying the duty cycle. A prospective multicenter clinical trial to evaluate the safety and efficacy of a right atrial ablation procedure using this technology to treat atrial fibrillation is currently underway. To date, 15 patients have been enrolled and the procedure was acutely effective in 14 of 15 patients with no complications. Atrial fibrillation has recurred during short-term follow-up in 12 of 15 patients, a not surprising result, because this initial phase of testing involved only right-sided ablation. The early results of the phase I clinical trial confirm the findings of others that successful ablation of chronic atrial fibrillation is likely to require a left atrial approach. This clinical trial, as well as others that are currently underway, will be invaluable in the continuing development of catheter ablation of atrial fibrillation and, ultimately, in determining if the routine use of this therapeutic tool can become a reality.
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      References

        • Gallagher J.J
        • Svenson R.H
        • Kasell J.H
        • German L.D
        • Bardy G.H
        • Broughton A
        • Critelli G
        Catheter technique for closed-chest ablation of the atrioventricular conduction system.
        N Engl J Med. 1982; 306: 194-200
        • Jackman W.M
        • Wang X
        • Friday K.J
        • Roman C.A
        • Moulton K.P
        • Beckman K.J
        • McClelland J.H
        • Twidale N
        • Hazlitt A
        • Prior M.I
        • Margolis P.D
        • Calame J.D
        • Overholt E.D
        • Lazzara R
        Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current.
        N Engl J Med. 1991; 324: 1605-1611
        • Calkins H
        • Sousa J
        • El-Atassi R
        • Rosenheck S
        • DeBuitleir M
        • Kou W.H
        • Kadish A.H
        • Langberg J.J
        • Morady F
        Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiology test.
        N Engl J Med. 1991; 324: 1612-1618
        • Calkins H
        • Langberg J
        • Sousa J
        • El-Atassi R
        • Leon A
        • Kou W
        • Kalbfleisch M.D
        • Morady F
        Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients.
        Circulation. 1992; 85: 1337-1346
        • Kay G.N
        • Epstein A.E
        • Dailey S.M
        • Plumb V.J
        Role of radiofrequency ablation in the management of supraventricular arrhythmias.
        J Cardiovasc Electrophysiol. 1993; 4: 371-389
        • Kottkamp H
        • Hindricks G
        • Willems S
        • Chen X
        • Reinhardt L
        • Haverkamp W
        • Breithardt G
        • Borggrefe M
        An anatomically and electrogram-guided stepwise approach for effective and safe catheter ablation of the fast pathway for elimination of atrioventricular node reentrant tachycardia.
        J Am Coll Cardiol. 1995; 25: 974-983
        • Haissaguerre M
        • Gaita F
        • Fischer B
        • Commenges D
        • Montserrat P
        • d’Ivernois C
        • Lemetayer P
        • Warin J.-F
        Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy.
        Circulation. 1992; 85: 2162-2175
        • Jackman W.M
        • Beckman K.J
        • McClelland J.H
        • Wang X
        • Friday K.J
        • Roman C.A
        • Moulton K.P
        • Twidale N
        • Hazlitt A
        • Prior M.I
        • Oren J
        • Overholt E.D
        • Lazzara R
        Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction.
        N Engl J Med. 1992; 327: 313-318
        • Calkins H
        • Yong P
        • Miller J.M
        • Olshansky B
        • Carlson M
        • Saul J.P
        • Huang S.K
        • Liem L.B
        • Klein L.S
        • Moser S
        • Bloch D
        • Gillette P
        • Prystowsky E
        • the Atakr Multicenter Investigations Group
        Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction.
        Circulation. 1999; 99: 262-270
        • Lesh M.D
        • Van Hare G.F
        • Epstein L.M
        • Fitzpatrick A.P
        • Scheinman M.M
        • Lee R.J
        • Kwasman M.A
        • Grogin H.R
        • Griffin J.C
        Radiofrequency catheter ablation of atrial arrhythmias.
        Circulation. 1994; 89: 1074-1089
        • Feld G.K
        • Fleck R.P
        • Chen P.-S
        • Boyce K
        • Bahnson T.D
        • Stein J.B
        • Calisi C.M
        • Ibarra M
        Radiofrequency catheter ablation for the treatment of human type I atrial flutter.
        Circulation. 1992; 86: 1233-1240
        • Cosio F.G
        • Lopez-Gil M
        • Goicolea A
        • Arribas F
        • Barroso J.L
        Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter.
        Am J Cardiol. 1993; 71: 705-709
        • Cox J.L
        • Boineau J.P
        • Schuessler R.B
        • Kater K.M
        • Lappas D.G
        Five-year experience with the MAZE procedure for atrial fibrillation.
        Ann Thorac Surg. 1993; 56: 814-824
        • Cox J.L
        • Boineau J.P
        • Schuessier R.B
        • Ferguson T.B
        • Cain M.E
        • Lindsay B.D
        • Corr P.B
        • Kater K.M
        • Lappas D.G
        Successful surgical treatment of atrial fibrillation.
        JAMA. 1991; 266: 1976-1980
        • Sundt T.M
        • Camillo C.J
        • Cox J.L
        The MAZE procedure for cure of atrial fibrillation.
        Cardiol Clin. 1997; 15: 739-748
        • Cox J.L
        • Jaquiss R.D.B
        • Schuessler R.B
        • Boineau J.P
        Modification of the MAZE procedure for atrial flutter and atrial fibrillation.
        J Thorac Cardiovasc Surg. 1995; 110: 485-495
        • Cox J.L
        • Boineau J.P
        • Schuessler R.B
        • Kater K.M
        • Lappas D.G
        Five-year experience with the MAZE procedure for atrial fibrillation.
        Ann Thorac Surg. 1993; 56: 814-824
        • Cox J.L
        • Boineau J.P
        • Schuessler R.B
        • Kater K.M
        • Lappas D.G
        From fisherman to fibrillation.
        Ann Thorac Surg. 1994; 58: 1269-1273
        • Swartz J.F
        • Perrersels G
        • Silvers J
        • Patten L
        • Cervantez D
        A catheter based curative approach to atrial fibrillation in humans.
        Circulation. 1994; 90 (Abstr.): I-335
      1. Swartz JF. Catheter based cure of atrial fibrillation. One year later: what have we learned? Presented at the North American Society of Pacing and Electrophysiology 17th Scientific Sessions, Seattle, WA, May 15, 1996.

        • Haissaguerre M
        • Marcus F.I
        • Fischer B
        • Clementy J
        Radiofrequency catheter ablation in unusual mechanisms of atrial fibrillation.
        J Cardiovasc Electrophysiol. 1994; 5: 743-751
        • Haissaguerre M
        • Gencel L
        • Fischer B
        • Metayer P.L
        • Poquet F
        • Marcus F.I
        • Clementy J
        Successful catheter ablation of atrial fibrillation.
        J Cardiovasc Electrophysiol. 1994; 5: 1045-1052
        • Haissaguerre M
        • Jais P
        • Shah D.C
        • Gencel L
        • Pradeau V
        • Garrigues S
        • Chouairi S
        • Hocini M
        • Metayer P.L
        • Roudaut R
        • Clementy J
        Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation.
        J Cardiovasc Electrophysiol. 1996; 7: 1132-1144
        • Scherf D
        Studies on auricular tachycardia caused by aconitine administration.
        Proc Soc Exp Biol Med. 1947; 4: 233-239
        • Cox J.L
        • Canavan T.E
        • Schuessler R.B
        • Cain M.E
        • Lindsay B.D
        • Stone C
        • Smith P.R
        • Corr P.B
        • Boineau J.P
        The surgical treatment of atrial fibrillation 2.
        J Thorac Cardiovasc Electrophysiol. 1991; 101: 406-426
        • Moe G.K
        On the multiple wavelet hypothesis of atrial fibrillation.
        Arch Int Pharmacodyn Ther. 1962; 140: 183-188
        • Moe G.K
        • Rheinholdt W.C
        • Abildskov J
        A computer model of atrial fibrillation.
        Am Heart J. 1964; 67: 200-220
        • Konings K.T.S
        • Kirchof C.J.H.J
        • Smeets J.R.L.M
        • Wellens H.J.J
        • Penn O.C
        • Allessi M.A
        High density mapping of electrically induced atrial fibrillation in humans.
        Circulation. 1994; 89: 1665-1680
        • Allessie M.A
        • Rensma P.L
        • Brugada J
        • Smeets J.L
        • Penn O
        • Kirchhof C.J
        Pathophysiology of atrial fibrillation.
        in: Zipes D Jalife J Cardiac Electrophysiology From Cell to Bedside. WB Saunders, Philadelphia1990: 548-559
        • Jais P
        • Haissaguerre M
        • Shah D.C
        • Chouairi S
        • Gencel L
        • Hocini M
        • Clementy J
        A focal source of atrial fibrillation treated by discrete radiofrequency ablation.
        Circulation. 1997; 95: 572-576
        • Gaita F
        • Riccardi R
        • Calo L
        • Scaglione M
        • Garberoglio L
        • Antolini R
        • Kirchner M
        • Lamberti F
        • Richiardi E
        Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation.
        Circulation. 1998; 97: 2136-2145
        • Haiassaguerre M
        • Jais P
        • Shah D.C
        • Takahashi A
        • Hocini M
        • Quiniou G
        • Garrigue S
        • Mouroux A.L
        • Metayer P.L
        • Clementy J
        Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
        N Engl J Med. 1998; 339: 659-666
      2. Man KC, Daoud E, Knight B, Weiss R, Bahu M, Harvey M, Goyal R, Bogun F, Strickberger SA, Morady F. Right atrial radiofrequency catheter ablation of paroxysmal atrial fibrillation. (Abstr.) J Am Coll Cardiol 1996;27(suppl A):768–761.

        • Maloney J.D
        • Milner L
        • Markel M
        • Barold S
        • Czerska B
        Biatrial linear and focal ablation to restore sinus rhythm in patients with refractory atrial fibrillation, procedure experience and follow up beyond one year.
        PACE Pacing Clin Electrophysiol. 1998; 21 (Abstr.): 530
        • Hwang C
        • Karaguezian H.S
        • Chen P.S
        The left atrial tract within the ligament of Marshall as the source for focal atrial fibrillation.
        PACE Pacing Clin Electrophysiol. 1998; 21 (Abstr.): 60
        • Haines D.E
        • Langberg J.J
        • Lesh M.D
        • Leon A.R
        • Mitchell M.M
        • DeLurgio D.B
        Catheter ablation of atrial fibrillation using the multiple electrode catheter ablation (MECA) system.
        PACE Pacing Clin Electrophysiol. 1998; 21 (Abstr.): 169
        • Kuck K.H
        • Ernst S
        • Khanedani A
        • Braun E
        • Ouyang F
        • Volkmer M
        • Antz M
        • Hebe J
        Clinical follow-up after primary catheter-based ablation of atrial fibrillation using the CARTO system.
        PACE Pacing Clin Electrophysiol. 1998; 21 (Abstr.): 313
        • Sherman M
        • Simpson J
        • Bowe W
        • Castellano T
        • Desai J.M
        • Hall J.A
        • Walcott G.P
        • Kay G.N
        A system for the creation of long linear lesions utilizing duty cycle controlled phased radiofrequency energy.
        PACE Pacing Clin Electrophysiol. 1998; 21 (Abstr.): 373
        • Cox J.L
        • Sundt J.M
        The surgical management of atrial fibrillation.
        Annu Rev Med. 1997; 48: 511-523