Double Multielectrode Mapping Catheters Facilitate Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating from Pulmonary Veins

Hsieh, Ming‐Hsiung; Chen, Shih‐Ann; Tai, Ching‐Tai; Tsai, Chin‐Feng; Prakash, Varsha; Yu, Wen‐Chung; Liu, Chuen-Chia; Ding, Yu‐An; Mei, Chao

doi:10.1111/j.1540-8167.1999.tb00654.x

Cited by 102 publications

(80 citation statements)

References 20 publications

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“…As described previously, all antiarrhythmic drugs were discontinued for at least 5 half-lives before the study. 9,10 The patients who took amiodarone for management of AF were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…[11][12][13][14][15] Electrophysiological Study and Catheter Ablation As described previously, 2 multipolar electrode catheters were placed in the anterolateral right atrium and His bundle area for recording and pacing. 10 A 7F decapolar catheter was inserted into the coronary sinus. After a successful atrial transseptal puncture, 2 exchange guidewires were introduced into the left atrium through the interatrial septum, and then 2 long sheaths (8F SR0 for left superior pulmonary vein [LSPV] and 8.5F SL1 for right superior pulmonary vein [RSPV]; Daig Co) were advanced along the guidewires into the left atrium.…”

Section: Heart Rate Variabilitymentioning

confidence: 99%

“…Recently, RF catheter ablation of pulmonary veins (PVs) has been demonstrated to cure focal atrial fibrillation (AF). [7][8][9][10] However, transient sinus bradycardia, sinus arrest, and hypotension have been reported as complications during focal ablation of PVs, and thermal stimulation of vagus nerve fibers might play an important role in these complications. 9 Therefore, the purpose of the present study was to evaluate the effects of focal PVs ablation on autonomic function by using HRV.…”

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confidence: 99%

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Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins

et al. 1999

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Background-Transient sinus bradycardia and hypotension have been reported as complications during radiofrequency (RF) ablation of focal atrial fibrillation (AF) originating from pulmonary veins (PVs). This study used heart rate variability (HRV) to evaluate the effects of focal PVs ablation on autonomic function. Methods and Results-Thirty-seven patients with paroxysmal AF were referred for ablation. The study group included 30 patients who underwent transseptal ablation of PVs, and the control group included 7 patients who underwent the transseptal procedure without ablation. The mean sinus rate and time-domain (standard deviation of RR intervals and root-mean-square of differences of adjacent RR intervals) and frequency-domain (low frequency, high frequency, and low-frequency/high-frequency ratio) analyses of HRV were obtained by use of 24-hour Holter monitoring before and 1 week, 1 month, and 6 months after ablation. All the triggering points of AF were from PVs, and they were successfully ablated. Severe bradycardia and hypotension were noted during ablation of PVs in 6 patients (group IA); 24 patients without the above complication belonged to group IB. Compared with preablation values, a significant increase in mean sinus rate and low-frequency/high-frequency ratio and a significant decrease in standard deviation of RR intervals, root-mean-square of differences of adjacent RR intervals, low frequency, and high frequency were noted in groups IA and IB patients 1 week after ablation. The changes in HR and HRV recovered spontaneously in the 2 subgroups by 1 month later. These parameters of HRV did not change in the control group after the transseptal procedure. Conclusions-Transient autonomic dysfunction with alterations in HR and HRV occurred after ablation of focal AF

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“…As described previously, all antiarrhythmic drugs were discontinued for at least 5 half-lives before the study. 9,10 The patients who took amiodarone for management of AF were excluded.…”

Section: Methodsmentioning

confidence: 99%

Section: Heart Rate Variabilitymentioning

confidence: 99%

mentioning

confidence: 99%

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Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins

et al. 1999

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“…7,9 -11 Because these patients had clinically documented spontaneous onset of PAF, we tried to find spontaneous ectopic beats initiating AF before or after the infusion of isoproterenol or after the previously designed algorithm used for facilitating the initiation of AF. 11 If a consistent ectopic focus and onset pattern of spontaneous AF was confirmed, the earliest ectopic site was considered to be the initiating focus of AF. The methods used to facilitate spontaneous AF were tried at least twice to ensure reproducibility.…”

Section: Electrophysiological Studymentioning

confidence: 99%

Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Superior Vena Cava

Tsai¹,

et al. 2000

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Background-The superior vena cava (SVC) has cardiac musculature extending from the right atrium. However, no previous study in humans has given details regarding the ectopic foci that initiate paroxysmal atrial fibrillation (PAF), which may originate from the SVC. Methods and Results-A total of 130 patients with frequent attacks of PAF initiated by ectopic beats were included. Eight patients (6%) had spontaneous AF initiated by a burst of rapid ectopic beats from the SVC (located 19Ϯ7 mm above the junction of the SVC and right atrium), which was confirmed by multiplane angiographic and intracardiac echocardiographic visualization and was marked by a sharp SVC potential preceding atrial activity. During initial repetitive discharges, the group with SVC ectopy had a higher incidence of intravenous conduction block than the group with pulmonary vein ectopy (75% versus 37%; Pϭ0.03). The activation time of the earliest intracardiac ectopic activities relative to ectopic P wave onset was significantly shorter in the SVC ectopy than the pulmonary vein ectopy group (37Ϯ15 versus 84Ϯ32 ms; PϽ0.001). After 5Ϯ3 applications of radiofrequency energy, AF was eliminated. SVC angiography after ablation revealed a local indentation of the venous wall in one patient. Two patients manifested coexisting sinus rhythm and a "focal" fibrillating activity confined inside the SVC after radiofrequency ablation. During a follow-up period of 9Ϯ3 months, all 8 patients were free of antiarrhythmic drugs, without tachycardia recurrence or symptoms of SVC obstruction. Conclusions-Ectopic beats initiating PAF can originate from the SVC. A radiofrequency current delivered to eliminate these ectopies is a highly effective and safe way to prevent PAF. (Circulation. 2000;102:67-74.)

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“…[1][2][3][4][5][6] However, an atrial transseptal procedure is necessary to localize the initiating foci of AF, and this procedure may increase the risk of cardiac perforation. 7,8) Some AEBs triggering AF originate from right atrial foci such as the superior vena cava, crista terminalis (CT), and coronary sinus (CS) ostium. [9][10][11] Thus, accurate localization of the initiating foci of AF before the transseptal procedure may help in the ablation procedure and in shortening the procedure and ablation times.…”

Section: Introductionmentioning

confidence: 99%

Identifying the Origin of Right and Left Ectopic Atrial Beats Triggering Atrial Fibrillation before Atrial Transseptal Procedure

Ohkubo

Watanabe

Okumura

et al. 2006

Journal of Arrhythmia

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Atrial premature depolarizations (APDs) triggering atrial fibrillation (AF) originate from mainly the pulmonary veins (PVs), but, in some cases, atrial ectopic beats (AEBs) triggering AF originate from the right atrium (RA) or the superior vena cava. Accurate identification of the origin of APDs in the PVs by means of RA and coronary sinus mapping is difficult. Purpose: The aim of this study was to identify the origin of AEBs triggering AF before transseptal catheterization. Electrode catheters were placed in the posteroseptal RA (PSRA), right pulmonary artery (RPA), left pulmonary artery (LPA), and esophagus in 10 patients with paroxysmal AF. We analyzed endocardial electrograms from the PSRA, RPA and LPA, and epicardial electrograms from the esophagus. The origin of the AEBs in the PVs was determined before PV ablation by mapping 4 PVs simultaneously. Four AEBs originated from the left superior PV (LSPV), 2 from the left inferior PV (LIPV), 4 from the right superior PV (RSPV), 2 from the RA or superior vena cava. In AEBs originating from the RA, the PSRA activation was the earliest and it proceeded in a cranial to caudal direction. In AEBs originating from the RUPV, RPA was the earliest. The esophageal activation sequence was in a cranial to caudal direction. In AEBs from the LSPV, LPA was the earliest and the esophageal activation sequence proceeded in a cranial to caudal direction. In AEDs from LIPV, LPA was the earliest, and the esophageal activation sequence was nearly simultaneous. Atrial activation sequences from the PSRA, RPA, LPA, and esophageal catheters can accurately identify the location of the initiating foci of AF before a transseptal procedure. (J Arrhythmia 2006; 22: 216-224)

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Double Multielectrode Mapping Catheters Facilitate Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating from Pulmonary Veins

Abstract: The technique using double multielectrode mapping catheters is a relatively safe and highly effective method for mapping and ablation of focal AF originating from PVs.

Cited by 102 publications

References 20 publications

Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins

Alterations of Heart Rate Variability After Radiofrequency Catheter Ablation of Focal Atrial Fibrillation Originating From Pulmonary Veins

Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Superior Vena Cava

Identifying the Origin of Right and Left Ectopic Atrial Beats Triggering Atrial Fibrillation before Atrial Transseptal Procedure

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