Catheter Ablation of Atrial Fibrillation in the Last 10 Years: Breakthroughs and Advances Dr. Feifan Ouyang Asklepios Klinik St. Georg Hamburg Sept. 19th, 2008, Hangzhou Haissaguerre et al. NEJM 1998, 339: 659-666 Haissaguerre et al. NEJM 1998, 339: 659-666 Haissaguerre et al. NEJM 1998, 339: 659-666 Success: 62% with a median FU of 8 6 M Haissaguerre et al. Circulation 2000; 102: 2463-2465 Haissaguerre et al. Circulation 2000; 102: 2463-2465 Recurrence in 31 out of 70 pts (44%) -Reablation in 29 of these 31 pts -Freedom of AF: 73% at a median of FU of 4 5 M No PV stenosis！ 162 PVs (no RIPV) in 70 Pts -one breakthrough in 34 PV -two breakthroughs in 77 PVs -two breakthrough in 51PVs Catheter ablation of atrial fibrillation 1. Successful acute PV isolation rate almost 100% in experienced centers 2. Clinical success rate: variable 50-93 (65)% with multiple procedures 3. Recovered“ PV spikes in 95% pts during reprocedures 4. PV severe stenosis/occlusion 1% 5. Effect only on the PV, but not in the PV antrum Segmental PV isolation Cappato et al. Circulation 2003;108:15991604 Ernst et al. Circulation 1999; 100:2085 13 pts 32 pts Ernst et al. Circulation 1999; 100:2085 No SR SR in 2/32 pts Schmidt et al. JCE 2006;17:957964 2000 2004 1999 2001 Pappone C et al. Circulation 1999, 2000, 2001, and 2004 Focal? Small circle within PVs 1.6 cm 1.94 cm 1.74 cm Pappone et al Circulation 2001 Validation of ablation area: Voltage mapping 20000 pts 90% in interm. AFib 90% in chron. AFib no detailed information, one with LA-Eso fistula Oral et al, Circulation 2003;108 Karch et al, Circulation 2005;110 Karch et al Circulation 2005;110 Oral et al Circulation 2003;108 Oral et al, Circulation 2003;108 Karch et al, Circulation 2005;110 Segmental PVI vs Circumferential PV Ablation Circumferential PV ablation Catheter ablation of atrial fibrillation Procedure endpoints Potential amplitude within the isolated area 5 years is still very limited except surgical approa