Attenuation of interatrial conduction using right atrial septal catheter ablation

• Published in: Journal of the American College of Cardiology Vol. 38; no. 3; pp. 892 - 899
• Main Authors: Schwartzman, David, Warman, Eduardo N, Devine, William A, Mehra, Rahul
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2001; Elsevier Science
• Subjects: Animals; Atrial Appendage - physiology; Atrial Function; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Pacing, Artificial; Cardiology. Vascular system; Catheter Ablation; Electrocardiography; Electrophysiologic Techniques, Cardiac; Heart; Heart Conduction System - surgery; Heart Septum - surgery; Medical sciences; Swine; Δmax; ERP; RAA; PDur; AF; AVN; ICE; ICT; LAA; SCL; Prognosis; Arrhythmia; Atrial fibrillation; Instrumentation therapy; Cardiovascular disease; Atrial septum; Radiofrequency; Ablation; Excitability disorder; Pig; Vertebrata; Mammalia; Treatment; Heart disease; Animal; Accessory bundle; Artiodactyla; Technique; Ungulata
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(01)01466-8

OBJECTIVES
We sought to characterize a method of attenuating interatrial conduction using radiofrequency ablated lesions applied to the right atrial septum.
BACKGROUND
Interatrial conduction occurs in specific zones. Recent data suggest that interatrial conduction can be important in triggering and sustaining atrial fibrillation. Therefore, a method for attenuating interatrial conduction may have therapeutic value.
METHODS
In 13 healthy pigs, interatrial conduction was evaluated before and after sequential ablation of the right atrial septum, targeting interatrial conduction zones. In six animals, zone 1 (crista terminalis and limbus) was ablated first, followed by ablation of zone 2 (fossa ovalis and coronary sinus ostium). In the other seven animals, the order of ablation was reversed. Electrophysiologic and pathologic findings were correlated.
RESULTS
After ablation of zone 1, interatrial conduction was slowed, but there was no block. After ablation of zone 2, conduction was unchanged. After ablation of both zones, complete block was observed in four animals, and there was left atrial quiescence. In the remaining nine animals, incomplete block was observed, with marked conduction slowing or block during sinus rhythm and pacing. Ablation did not adversely affect atrioventricular node conduction, nor did it facilitate sustenance of an atrial arrhythmia. Pathologic analysis revealed that complete interatrial conduction block was associated with confluent ablation of both targeted zones.
CONCLUSIONS
Catheter ablation of the right atrial septum attenuated interatrial conduction without disturbing atrioventricular conduction.