Korean Circ J.  2011 Aug;41(8):447-452. 10.4070/kcj.2011.41.8.447.

The Feasibility and Efficacy of a Large-Sized Lasso Catheter Combined With 3 Dimensional Mapping System for Catheter Ablation of Atrial Fibrillation

• Jang SW
• Shin WS
• Kim JH
• Choi MS
• Choi YS
• Oh YS
• Lee MY
• Rho TH

• KMID: 1826351
• DOI: http://doi.org/10.4070/kcj.2011.41.8.447

Abstract

BACKGROUND AND OBJECTIVES
We aimed to investigate whether a large-sized Lasso catheter could increase the success rate of immediate complete pulmonary vein (PV) antral isolation and improve the outcome of catheter ablation in atrial fibrillation (AF) patients.
SUBJECTS AND METHODS
This study included 107 consecutive patients (67 males, mean age: 57.8+/-9.7 years) who underwent PV mapping and ablation due to symptomatic drug-refractory AF. The first 43 patients underwent isolation of both ipsilateral PVs using the Carto-Merge 3 dimensional mapping system (group 1). The other 64 patients underwent isolation of both ipsilateral PVs using the same technique with a large-sized (a diameter of 30 to 35 mm) Lasso cathe-ter (group 2). When ipsilateral PVs did not show any potential after the initial circumferential ablation, we defined this as 'immediate complete antral isolation (ICAI)'. We compared the AF recurrence rate of both groups.
RESULTS
There was no significant difference of the clinical characteristics between group 1 and group 2. All the patients were followed-up for 1 year. The ICAI rate of group 1 and group 2 was significantly different (21% vs. 78%, p<0.001), and the AF recurrence rates of group 1 and group 2 were also different (34.9% vs. 18.8%, p=0.042). Using multiple logistic regression analysis, the use of a large-sized Lasso catheter was a significant predictive factor for preventing recurrence (odds ratio: 0.489, 95% confidence interval: 0.136-0.927).
CONCLUSION
It is likely that a large-sized Lasso catheter plays an important role in achieving ICAI and in lowering the rate of AF recurrence.

Keyword

Atrial fibrillation; Catheter ablation; Pulmonary vein; Tachycardia

MeSH Terms

Acetamides
Atrial Fibrillation
Carbamates
Catheter Ablation
Catheters
Humans
Logistic Models
Male
Organometallic Compounds
Pulmonary Veins
Recurrence
Tachycardia
Acetamides
Carbamates
Organometallic Compounds

Figure

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  Fig. 1 Three-dimensional mapping of the Carto-Merge on the right anterior oblique view. Circumferential ablation around both ipsilateral veins is shown by the red dots.

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  Fig. 2 Fluoroscopic image confirming the isolation of each pulmonary vein. A variable-sized Lasso catheter was used to verify conduction block between the pulmonary vein and the left atrium. Dashed lines are schemes of the ipsilateral pulmonary vein. A: right superior pulmonary vein. B: left superior pulmonary vein. C: right inferior pulmonary vein. D: left inferior pulmonary vein.

• 

  Fig. 3 Fluoroscopic image in which a large-sized Lasso catheter (35 mm) was used. In group 2 patients, a large-sized Lasso catheter was placed at the beginning of the antral ablation. Dashed lines are schemes of ipsilateral pulmonary vein. A: right pulmonary vein. B: left pulmonary vein.

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