Incidence and Time Course of Early Recovery of Pulmonary Vein Conduction after Catheter Ablation of Atrial Fibrillation

Cheema, Aamir; Dong, Jun; Dalal, Darshan; Marine, Joseph E.; Henrikson, Charles A.; Spragg, David D.; Cheng, Alan; Nazarian, Saman; Bilchick, Kenneth C.; Sinha, Sunil K.; Scherr, Douglas S.; Almasry, Ibrahim; Halperin, Henry R.; Berger, Ronald D.; Calkins, Hugh

doi:10.1111/j.1540-8167.2007.00760.x

Cited by 148 publications

(112 citation statements)

References 14 publications

Supporting

Mentioning

104

Contrasting

Order By: Relevance

“…4,5 Cheema et al 17 showed recurrence of PV conduction in >90% of patients 1 hour after initial electrical isolation. Cappato et al 4 demonstrated that late conduction recurrence across acutely disconnecting RF lesions delivered at the ostia of the multiple PVs is a common finding in patients undergoing catheter ablation of AF.…”

Section: Pv Reconnection and Recurrent Atrial Tachyarrhythmiasmentioning

confidence: 99%

Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Miyazaki

Kobori

Komatsu

et al. 2012

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Correspondence to Shinsuke Miyazaki, MD, Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki 300-0053, Japan. E-mail mshinsuke@k3.dion.ne.jp Background-Pulmonary vein reconnection after electrical isolation is commonly observed in the context of atrial fibrillation ablation and is associated with recurrent atrial tachyarrhythmias. Adenosine test was been performed to identify acute dormant conduction immediately after pulmonary vein isolation at index procedure. However, the utility of adenosine test at repeat procedure has not been reported. Methods and Results-We report 5 paroxysmal atrial fibrillation cases without any structural heart disease in which dormant thoracic vein conduction was associated with recurrent atrial tachyarrhythmias. All patients had undergone circumferential ipsilateral pulmonary vein isolation at the index procedure. Superior vena cava isolation was performed if superior vena cava-triggered atrial fibrillation was identified. At the index procedure, adenosine test did not provoke venous reconduction. At the repeat procedure, adenosine provoked clinical arrhythmia in 4 out of 5 cases after transient reconnection between culprit thoracic vein and atrium despite absence of reconnection at the start of the procedure. After the elimination of the dormant conduction gaps, all patients were free from recurrent arrhythmia. Conclusions-Adenosine provokes dormant thoracic vein conduction associated with the late recurrence of atrial tachyarrhythmias after previous thoracic vein isolation. Thus, adenosine provocation test can specifically help identify and target the cause of recurrent atrial arrhythmia. (Circ Arrhythm Electrophysiol. 2012;5:1117-1123.)

show abstract

Section: Pv Reconnection and Recurrent Atrial Tachyarrhythmiasmentioning

confidence: 99%

Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Miyazaki

Kobori

Komatsu

et al. 2012

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…9,10 With discontinuous and nontransmural ablation lines being one of the reasons for recurrences of AF and atrial macroreentrant tachycardia (MRT), steerable sheaths were designed to improve access to and contact with ablation target sites. 11,12 To build up scientific evidence on the clinical use of that technology, we published data from a retrospectively matched case-control analysis indicating a significantly superior rhythm control compared with an ablation approach with a nonsteerable sheath access. 10 On the basis of these results, we have now planned and conducted a prospective randomized study to further strengthen scientific evidence on clinical outcome and safety to support usage of steerable sheath technology in clinical routine of AF catheter ablation (ClinicalTrials.gov Identifier: NCT00469638).…”

Section: Clinical Perspective On P 165mentioning

confidence: 99%

“…Clinically, that problem results in a significant number of AF/ MRT recurrences caused by (1) primarily incomplete PV isolation, 7 (2) too distally isolated PVs, 16 and (3) the occurrence of PV reconduction. 12 Sufficient and stable catheter-to-tissue contact in all intended ablation target sites is one of the challenges interventionalists are facing while trying to place complex 3D ablation line concepts in a moving organ within a breathing patient. Steerable transseptal sheath technology has been developed to facilitate access and contact to ablation target sites to improve continuity, transmurality, and maintenance of radiofrequency lesion formation.…”

Section: Role Of Catheter Access and Catheter Contact For Af Ablationmentioning

confidence: 99%

Steerable Versus Nonsteerable Sheath Technology in Atrial Fibrillation Ablation

Piorkowski

Eitel

Rolf

et al. 2011

Circ: Arrhythmia and Electrophysiology

110

View full text Add to dashboard Cite

Background-Steerable sheath technology is designed to facilitate catheter access, stability, and tissue contact in target sites of atrial fibrillation (AF) catheter ablation. We hypothesized that rhythm control after interventional AF treatment is more successful using a steerable as compared with a nonsteerable sheath access. Methods and Results-One hundred thirty patients with paroxysmal or persistent drug-refractory AF undergoing their first ablation procedure were prospectively included in a randomized fashion in 2 centers. Ablation was performed by 10 operators with different levels of clinical experience.

show abstract

“…In (Figure 3). 60,[63][64][65][66] Taken together it is not surprising that the UNDER-ATP trial and Ghanbari et al had a higher rate of spontaneous PV reconnection (42.6 % in UNDER-ATP versus 27 % in ADVICE) and a lower rate of DC (27.6 % versus 53 % in the ADVICE study and 37 % in the Ghanbari et al study). [53][54][55][56][57]60 Third, as a result of the low prevalence of DC the UNDER-ATP trial was underpowered.…”

Section: Clinical Valuementioning

confidence: 91%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

show abstract

Incidence and Time Course of Early Recovery of Pulmonary Vein Conduction after Catheter Ablation of Atrial Fibrillation

Cited by 148 publications

References 14 publications

Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Steerable Versus Nonsteerable Sheath Technology in Atrial Fibrillation Ablation

Pharmacological Tests in Atrial Fibrillation Ablation

Contact Info

Product

Resources

About