Catheter Ablation of Chronic Atrial Fibrillation Targeting the Reinitiating Triggers

Haı̈ssaguerre, Michel; Jaı̈s, Pierre; Shah, Dipen; Arentz, Thomas; Kalusche, D.; Takahashi, Atsushi; Garrigue, Stéphane; Hocini, Mélèze; Peng, Jing; Clémenty, Jacques

doi:10.1111/j.1540-8167.2000.tb00727.x

Cited by 168 publications

(91 citation statements)

References 41 publications

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“…In other patients, single or multiple extrasystoles from the PV foci induce self-sustaining AF, and ablation of these foci eliminates the reinitiation of AF ("focal trigger"). 2 Clinical experience from several centers suggests that these foci may be responsive to autonomic manipulation, eg, with isoproterenol, 3 which often increases the rate and frequency of ectopic beats.…”

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confidence: 99%

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Arrhythmogenic Substrate of the Pulmonary Veins Assessed by High-Resolution Optical Mapping

et al. 2003

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Background-It has recently been recognized that atrial fibrillation can originate from focal sources in the pulmonary veins (PVs). However, the mechanisms of focal atrial fibrillation have not been well characterized. We assessed the electrophysiological characteristics of the PVs using high-resolution optical mapping. Methods and Results-Coronary-perfused, isolated whole-atrial preparations from 33 normal dogs were studied.Programmed electrical stimulation was performed, and a 4-cm 2 area of the PV underwent optical mapping of transmembrane voltage to obtain 256 simultaneous action potentials. Marked conduction slowing was seen at the proximal PV, compared with the rest of the vein, on both the epicardial (31.3Ϯ4.47 versus 90.2Ϯ20.7 cm/s, Pϭ0.001) and endocardial (45.8Ϯ6.90 versus 67.6Ϯ10.4 cm/s, Pϭ0.012) aspects. Pronounced repolarization heterogeneity was also noted, with action potential duration at 80% repolarization being longest at the PV endocardium. Nonsustained reentrant beats were induced with single extrastimuli, and the complete reentrant loop was visualized (cycle length, 155Ϯ30.3 ms); reentrant activity could be sustained with isoproterenol. Sustained focal discharge (cycle length, 330 to 1100 ms) was seen from the endocardial surface in the presence of isoproterenol; each focus was localized near the venous ostium. Conclusions-The normal PV seems to have the necessary substrate to support reentry as well as focal activity. Although reentry occurred more distally in the vein, focal activity seemed to occur more proximally.

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“…1,2 In some cases, these foci are very rapid, and sustained activity induces and maintains AF, such that ablation of the foci terminates and eliminates AF ("focal driver"). In other patients, single or multiple extrasystoles from the PV foci induce self-sustaining AF, and ablation of these foci eliminates the reinitiation of AF ("focal trigger").…”

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confidence: 99%

Arrhythmogenic Substrate of the Pulmonary Veins Assessed by High-Resolution Optical Mapping

et al. 2003

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“…[1][2][3][4][5][6][7][8][9][10] Conventional, manually deflected ablation catheters have several inherent limitations. Catheter deflection occurs with a fixed radius in a single plane restricting the freedom of movement.…”

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Novel, Magnetically Guided Catheter for Endocardial Mapping and Radiofrequency Catheter Ablation

et al. 2002

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Background-Ablation of complex arrhythmias would be greatly facilitated by more precise control of ablation catheters.A feasibility study was performed in animals to evaluate a novel magnetic guidance system (MGS) that generates a magnetic field to control the movement and position of a magnetic ablation catheter. Methods and Results-The MGS is composed of a digital biplanar fluoroscope within an array of superconducting electromagnets that surround the torso of the experimental animal and a computer control system that generates a composite magnetic field for directional catheter deflection. Magnetic catheter navigation was performed in dogs and pigs (20 to 30 kg). A 7F magnetic ablation catheter was used for intracardiac navigation and radiofrequency ablation. The performance of a standard 7F deflectable catheter was not affected by the MGS. The magnetic catheter was navigated successfully to 51 predefined targets throughout the heart in 6 animals. In 5 animals, the magnetic catheter, guided by a 3D computed tomogram, was successfully navigated to all pulmonary veins. Navigation accuracy was estimated as Ͻ1 mm displacement from the target. The magnetic catheter was used to ablate the atrioventricular node in 4 animals and to perform linear ablations across the endocardial surface underlying an epicardial multielectrode recording plaque in 4 animals. Conclusions-These results demonstrate that the MGS can navigate and stabilize an ablation catheter at endocardial targets. Linear or focal radiofrequency ablation with the magnetic catheter is not compromised by the magnetic field.

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“…1,2 An anatomic approach targeting the substrate for AF maintenance, by ablating the left atrium surrounding the PVs, was concurrently developed, 3 which in a randomized trial has proven to have a lower recurrence risk than PV isolation (PVI). 4 Recurrent AF after PVI could be related to failure to maintain conduction block from the PVs or the presence of non-PV triggering foci.…”

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confidence: 99%

Resumption of Electrical Conduction in Previously Isolated Pulmonary Veins

et al. 2004

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Background-Atrial fibrillation (AF) may recur after pulmonary vein isolation (PVI) as the result of either recurrent PV conduction or non-PV foci. This study characterized the electrophysiological findings of patients with recurrent AF after initially successful PVI and the clinical outcome after a repeat procedure. Methods and Results-Among 185 patients undergoing PVI, 52 reported no significant improvement in their clinical course. We analyzed PV conduction in 51 PVs (15 patients) at repeat PVI. All PVs were isolated with either RF (30 W, 50°C, 60 seconds) or cryoablation (Ϫ80°C for 5 minutes). At repeat study, 42 of the previously isolated 51 PVs had return of conduction. All patients had recurrent conduction in Ն2 PVs, with only 1 non-PV focus identified. The mean number of RF applications required to re-isolate the PVs was fewer at the repeat compared with the initial procedure (10Ϯ6 versus 4Ϯ2, PϽ0.005). Over a period of 15Ϯ6 months, all but 1 patient was clinically improved by the second procedure. Conclusions-In patients with recurrent AF after PVI, return of PV conduction can be expected. Repeat PVI provides significant clinical benefit for these patients. These results suggest that if permanent PV isolation is the ablation strategy, different techniques may be required to improve long-term efficacy.

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Catheter Ablation of Chronic Atrial Fibrillation Targeting the Reinitiating Triggers

Cited by 168 publications

References 41 publications

Arrhythmogenic Substrate of the Pulmonary Veins Assessed by High-Resolution Optical Mapping

Arrhythmogenic Substrate of the Pulmonary Veins Assessed by High-Resolution Optical Mapping

Novel, Magnetically Guided Catheter for Endocardial Mapping and Radiofrequency Catheter Ablation

Resumption of Electrical Conduction in Previously Isolated Pulmonary Veins

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