Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter

Kumagai, Koji; Ogawa, Masahiro; Noguchi, Hiroo; Yasuda, Tomoo; Nakashima, Hideko; Saku, Keijiro

doi:10.1016/j.jacc.2004.01.051

Cited by 178 publications

(88 citation statements)

References 14 publications

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“…95,96 Electrophysiological evaluation of the PVs using multielectrode basket catheters has revealed effective refractory period (ERP) heterogeneity and anisotropic conduction properties within the PV and at the PV–LA junction, which can provide a substrate for reentry. 97 The response of PV activity to adenosine administration in patients with PAF is more consistent with a reentrant than a focalectopic type of mechanism. 98,99 In addition, dominant frequency analysis points to an evolution of mechanisms in patients with AF, with PV sources becoming less predominant as AF becomes more persistent and atrial remodeling progresses.…”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 86%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 86%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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1,762

1,468

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“…Further, inducible ATs with stable circuits could also be successfully terminated by additional RF energy applications (91%), and the following AT episodes were significantly higher in the patients with than in those without residual ATs (26% versus 2%, respectively). Effects of a roof line on AF: PVs are dominant sources of triggers initiating AF in patients with paroxysmal AF, 7,8) however, a PV electrical isolation strategy alone for patients with an enlarged atrium or persistent AF may be quite limited. It is now recognized that the development of AF leads to electrical and structural changes within the atria that could allow for the promotion and maintenance of localized high-frequency activity (focal or reentrant), meandering multiple wavelet reentry, and macro-reentry.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological Features of Atrial Tachyarrhythmias After the Creation of a Left Atrial Roof Line During Catheter Ablation of Atrial Fibrillation

et al. 2011

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SummaryLeft atrial roof line (LARL) can prevent the perpetuation of atrial fibrillation (AF) by delineation of the arrhythmogenic substrate, but it may be associated with an increased incidence of atrial tachycardia (AT). This study was performed to evaluate the characteristics and clinical implications of inducible AT after LARL.A total of 139 consecutive patients with AF who underwent catheter ablation were prospectively enrolled in this study. LARL was required to prevent the perpetuation of AF in 98 of 139 patients (71%). LARL significantly reduced the incidence of inducible AF (before versus after: 100% versus 44%, respectively, P < 0.01), whereas it significantly increased the incidence of AT (18% versus 63%, P < 0.01). ATs were observed after LARL in 62 of 98 patients (63%), and these circuits were determined in 99 of 112 stable ATs (88%), including tricuspid isthmus-dependent (n = 35), mitral annulus (n = 22), septal (n = 15), surrounding right pulmonary veins (PVs) (n = 12), coronary sinus (CS) ostium (n = 4), upper loop (n = 4), surrounding left PVs (n = 4), and LA anterior wall (n = 3). Catheter ablation (CA) successfully terminated 111 of 122 stable ATs (91%) during CA. The occurrence of AT after CA was significantly higher in patients with than in those without residual AT (26% versus 2%, P < 0.05).Induced AT with a stable circuit after LARL creation could be mapped, and delineation of the induced AT may lead to a favorable outcome. An additional left atrial roof line (LARL) after pulmonary vein (PV) isolation prevents AF perpetuation by delineating the arrhythmogenic substrate with favorable clinical results, although it may be associated with an increased incidence of AT.6) In particular, AT with a macro-reentrant mechanism may be highly inducible after LARL creation.However, the characteristics of the AT have not been fully investigated after complete electrical PV isolation and creation of a complete electrical LARL in patients with AF. In this study, we evaluated the influence of LARL after PV isolation on the inducibility of atrial tachyarrhythmias (AF and ATs), and then assessed the electrical characteristics of the inducible ATs before and after LARL creation. MethodsStudy population: The study population consisted of 139 consecutive patients with drug-refractory episodes of AF who underwent initial radiofrequency CA (Table I). The mean age of the patients was 62 years, 82 (57%) were male, and 41 (29%) had persistent AF lasting more than 7 days (long-standing AF more than 6 months; 15 (11%)). Patients were considered for ablation based on the presence of symptomatic AF resistant to ≥ 1 antiarrhythmic drug. Cardiac structural findings assessed by ultracardiography are shown in Table II. No specific exclusion criteria were used. All antiarrhythmic agents were generally discontinued for at least 3 days before CA. Amiodarone was withdrawn at least 2 months before the procedure. All patients provided written informed consent for the electrophysiological study. This study was approved by our insti...

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“…Les mécanismes impliqués dans la production de l'activité ectopique par ces manchons musculaires, ainsi que le mécanisme exact de l'initiation de la FA par l'activité rapide ne sont à ce jour pas résolus. Il a cependant été démontré que les VP présentent une hétérogénéité des périodes réfractaires effectives qui pourrait favoriser la formation de réentrées [15]. Par ailleurs, sur la base d'études animales et histologiques, des mécanismes tels que la réentrée, l'automaticité augmentée ou l'activité déclen-chée ont été proposés [16].…”

Section: Foyers Déclenchantsunclassified

Mécanismes physiopathologiques de la fibrillation auriculaire

2008

Schweiz Ärzteztg

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SummaryThe pathophysiology of atrial fibrillation is complex, and appears to result from the interaction between initiating triggers, often in the form of rapidly firing ectopic foci located in the pulmonary veins, and an abnormal atrial tissue substrate capable of maintaining the arrhythmia through mechanisms such as multiple wavelet reentry or multiple rotors. Moreover, atrial remodelling, autonomic tone variations and inflammation also may be involved in the genesis and maintenance of atrial fibrillation. Ultimately, the recent understanding of some of these mechanisms has led to new therapeutic strategies, such as radiofrequency catheter and surgical ablation techniques. At the present time, a strategy of radiofrequency catheter ablation tailored to the burden of atrial fibrillation allows efficient management of patients, with a high rate of long-term freedom from recurrence of atrial fibrillation.

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Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter

Abstract: The presence of ERP heterogeneity and anisotropic conduction properties within the PV and at the PV-LA junction may be crucial to promote re-entry formation and thus might play an important role as a substrate for the maintenance of AF.

Cited by 178 publications

References 14 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Electrophysiological Features of Atrial Tachyarrhythmias After the Creation of a Left Atrial Roof Line During Catheter Ablation of Atrial Fibrillation

Mécanismes physiopathologiques de la fibrillation auriculaire

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