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We report the long-term follow-up of a right side only catheter ablation approach for paroxysmal AF. Eighteen patients with AE refractory to drugs entered the study. Ablation was attempted in the right atrium only by creating linear lesions based on a specific design including from two to four linear lesions. Induction of AF was attempted before ablation and after placement of the lesions. A septal lesion was performed in nine patients. In ten patients atrial defibrillation thresholds (ADETs) before ablation and following creation of the linear lesions were compared. After a mean follow-up of 22 ±11 months, seven patients had recurrence of AE, and another nine patients experienced atrial flutter or atrial tachycardia. Eive patients remained in sinus rhythm without medications and four required the use of drugs. Three patients had sporadic AF and six were in chronic AE. The recurrence rate was similar in patients with and without the septal lesion. However, a cure with right side ablation appeared to be predicted by the presence of disorganized and earlier activity in the high right atrium and crista terminalis. Linear lesions in the right atrium were associated with a lower ADET (pre 2.6 ± 04 J vs post 1.7 ± 0.6 J). In conclusion, in a small number of patients, control of AE can be obtained with a right side only approach. Gertain activation patterns may identify patients suitable to this approach. No specific lesion pattern appeared more effective. Right atrial linear lesions resulted in lower ADET. [ABSTRACT FROM AUTHOR]

Tridimensional Mapping: Guided Modification of the Sinus Node. Radiofrequency (RF) catheter modification of the sinus node appears to be a promising therapeutic modality for the treatment of inappropriate sinus tachycardia. Modification, as opposed to total obliteration, of the atrial pacemaker requires precise localization of the sinus node. This has been successfully achieved with a multicatheter approach guided by intracardiac echocardiography. This article describes the first clinical use of a tridimensional nonfluoroscopic mapping system to guide successful RF modification of the sinus node in two cases of inappropriate sinus tachycardia. This system simplifies the current approach and greatly reduces the fluoroscopy time. [ABSTRACT FROM AUTHOR]