Radiofrequency catheter ablation in patients with atrial fibrillation

Abstract

this novel technique, as well as to caution against the risk of developing pulmonary veno-occlusive syndrome, observed in one patient submitted to radiofrequency catheter ablation.Case 1 -The first patient was a 36 year-old male who had presented with occasional episodes of paroxistic AF for the past ten years, and daily recurrences for the past two years. He had failed to respond to quinidine associated to digoxine, amiodarone, sotalol and subsequently propafenone associated to atenolol. After clinical and echocardiographic evaluation, no systemic or structural heart disease was documented. Rest ECG was normal, but ambulatory Holter monitoring displayed several episodes of non-sustained AF following atrial premature beats and frequent episodes of atrial tachycardia.In June, 1998, an EP study was undertaken under deep sedation with propofol, midazolam and fentanyl. Three catheters were inserted percutaneously into the right femoral artery. A decapolar catheter was positioned at the lateral wall of the right atrium. An octapolar catheter was inserted into the coronary sinus, and a quadripolar catheter with a 4 mm tip was inserted in the left atrium, through a transeptal approach ( fig. 1). An intravenous bolus of heparin (5000 IU) was given, followed by a 1000 UI/hr continuous infusion.AF was recorded in left atrial electrograms, whereas right atrium electrograms were organized and regular ( fig. 2). Three direct current shocks (200 J) were delivered in an attempt to restore sinus rhythm, but that was maintained for only a few seconds, with AF recurrence (fig. 3). With the catheter positioned at the right inferior pulmonary vein, we observed that AF initiated after an atrial premature beat occurring earlier at that site when compared to the right atrial and coronary sinus signals. However, it did not precede peripheral P wave. The catheter was subsequently manipulated towards the left superior pulmonary vein (LSPV) ostium and another direct current 200 J shock delivered. After AF recurred, it could be observed that the atrial beat initiating the tachycardia was about 100 msec earlier at this site than the P wave preceding the tachycardia (fig. 4). A Recent reports have demonstrated that, in some patients, atrial fibrillation is triggered by ectopic foci originated from the pulmonary veins and that these foci can be effectively treated by radiofrequency pulses. In this report we confirm these findings in three patients with paroxistic atrial fibrillation refractory to antiarrhythmic drugs, while we caution against the occurrence of pulmonary veno-occlusive syndrome, observed in one of the patients after the second attempt to treat atrial fibrillation with RF ablation. We concluded that although RF pulses are effective to interrupt focal atrial fibrillation, multiple applications in the pulmonary veins can produce significant pulmonary vein stenosis. The significance of these findings remains to be determined after a longer follow-up.Atrial fibrillation (AF) is one of the most frequently found cardiac arrhythmia in...

Atrial Fibrillation Ablation: Reaching the Mainstream

“…The results are summarized in Tables I–III and in Figures 8 and 9. For linear ablation, 9 reports covered 443 patients 3–11 . The respective numbers for other techniques: focal 10 reports/508 patients 12–21 ; ostial isolation 343/2,187 22–55 ; circumferential including WACA/LACA 20/2,449 31,50,53,55–71 and PVAI 82/11,132; substrate ablation (CFAE) 8/559 51,152–158 ; and for surgical ablation 47/4,974 164–210 …”

Isolamento das veias pulmonares para tratamento da fibrilação atrial paroxística: resultados clínicos após um único procedimento

“…The electrophysiologic observation that atrial fibrillation is triggered by ectopic foci frequently originated in the pulmonary veins opened a new era in radiofrequency catheter ablation. However, just few patients presented frequent spontaneous ectopic beats enough to allow mapping of specific foci [2][3][4][5] . The attempts to apply the potential clinical benefits of AF triggers by catheter ablation presented major limitations.…”

Stenosis of the left pulmonary veins after atrial fibrillation catheter ablation

“…However, its occurrence still varies incidence, ranginges from 0.4 to 0.7%. (1)(2)(3) Symptoms associated with pulmonary vein stenosis are nonspecific and include dyspnea, cough, fatigue, chest pain, and hemoptysis. To increase the detection rate, it is advisable to maintain a low threshold for evaluation using imaging techniques like CTPA.…”