Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Pulmonary Veins

Abstract

Electrophysiological characteristics of PVs are different from those in the atria. Ectopic beats from PVs can initiate AF, and beta-adrenergic receptor blocker, calcium channel blockers, and sodium channel blockers can suppress these ectopic beats. Careful mapping and elimination of these ectopic foci can cure paroxysmal AF.

Catheter ablation of atrial fibrillation

“…A subsequent similar, but larger study by Chen et al 18 of 79 patients with frequent episodes of paroxysmal AF showed that focal RF applications completely eliminated 95% of the mapped ectopic foci, while during the 6 ± 2 month follow-up period 86.1% were free of AF without any antiarrhythmic drugs. In addition, Chen et al also looked at the possible adverse effects of focal ablation, and results from their followup transesophageal echocardiogram showed that 42.4% of ablated PVs had focal stenosis.…”

“…Pioneering work by Haïssaguerre et al showed that a rapidly firing focus in or close to the pulmonary veins (PVs) could be the cause of the arrhythmia in patients suffering from paroxysmal AF. 17 This initial finding has been subsequently confirmed by Chen et al 18 The successful mapping of arrhythmogenic foci to the PVs has unveiled a new target for catheter ablation, whereby ablation of these foci may prevent the initiation of AF. Figure 2 shows an ECG trace demostrating a short run of rapid atrial tachycardia, probably arising from the pulmonary veins, which on other occasions may produce AF.…”

“…Because uncertainty remains concerning the requisite number of lesions, their optimal location, and the need for continuous lines with the linear ablation approach, focal ablation has been proposed as the alternative on the basis of demonstration that ectopic beats originating within or at the ostium of pulmonary veins (PV) may be the source of paroxysmal or even persistent AF. 17,18,26 FIG. 2 Two-channel Holter electrocardiogram of a 39-year-old man with a history of paroxysmal atrial fibrillation.…”

“…18 To overcome these limitations, researchers have recently developed a novel catheter ablation approach that involves circumferential lesions created around the ostia of each PV, with the aim of isolating these veins electrically from the left atrium while reducing the risk of PV stenosis. 31,32 This approach eliminates the need for mapping, while it also has the advantage of being able to deal with multiple foci in the PVs, which possibly would not all have been mapped or ablated if the focal ablation approach had been employed.…”

Pulmonary vein isolation and left atrial catheter ablation using a three-dimensional navigation system for the treatment of atrial fibrillation

“…T he importance of pulmonary vein (PV) ectopics initiating atrial fibrillation (AF) has been the subject of numerous studies in recent years (1,2). Ablation of these triggering foci, while beneficial in the treatment of AF, has been associated with significant recurrence rates (3).…”