Electrogram polarity reversal as an additional indicator of breakthroughs from the left atrium to the pulmonary veins

Plasma brain natriuretic peptide concentrations in patients undergoing pulmonary vein isolation

“…The PV was mapped with a steerable circular catheter measuring 15-30 mm in diameter (according to the PV diameter as determined by venography) equipped with twenty 1 mm electrodes in a loop made of shape-retaining material (Lasso; Biosense Webster, Diamond Bar, California, USA) orthogonal to the shaft. The PV muscle potentials were defined as described previously 15 and were recorded in a bipolar mode from 10 bipoles through the band pass filters of 30-500 Hz and an amplification of 1 to 2 cm/mV on polygraphy (EP Med System; Century Medical, Tokyo, Japan).…”

“…Radiofrequency energy was delivered at the distal electrode (8 mm tip) of the thermocouple-equipped ablation catheter (target 50˚C) with a power limit of 30-35 W for 60 s. The end point was the establishment of bidirectional block between the LA and PV, as described previously. [15][16][17] Blood sampling and natriuretic hormone assays Blood samples were obtained in EDTA from each participant. Samples were centrifuged, and plasma was extracted, aliquoted and stored at 280˚C until analysis.…”

“…5 6 11 12 Pulmonary veins (PVs) are well recognised to play an important part in both the initiation and maintenance of AF. [13][14][15][16][17] Segmental ostial pulmonary vein isolation (PVI) procedures with radiofrequency currents have become more common for the treatment of AF that is unresponsive to drug treatment. [13][14][15][16][17] However, the influence of PVI on plasma BNP concentration has yet to be clarified.…”

Pace mapping in the atrium using bipolar electrograms from widely spaced electrodes

“…Traditionally, bipolar EGMs are recorded between two closely spaced electrodes in the heart. In some situations, polarity of bipolar EGMs may provide information on the direction of activation [8,9]. With these exceptions, EGM morphology in bipolar EGMs does not provide useful information because the short distance between the recording electrodes and their variable spatial relationships make the information unreliable.…”

Pulmonary Vein Morphology Before and After Segmental Isolation in Patients with Atrial Fibrillation

“…The muscle sleeve over the proximal portion of the PV is distributed heterogeneously, which is predominantly in the inferior portion of the superior PVs and in the superior portion of the inferior PVs 11 . A recent study also demonstrated that the sites with electrical breakthroughs where RF energy delivery impaired the conduction between the LA and the PV were often located at the superior and inferior segments within the PV 12 . In keeping with a heterogeneous distribution of the myocardial sleeve within the proximal PV and to isolate the PV electrically from the LA, RF energy has to be applied more often at the superior and inferior segments than at the anterior and posterior segments within the PV, which may result in heterogeneous PV stenosis.…”