Intraoperative map guided operation for atrial fibrillation due to mitral valve disease

Harada, Atsushi; Konishi, Toshio; Fukata, Mutsumu; Higuchi, Kazuhiko; Sugimoto, Takeshi; Sasaki, Kenji

doi:10.1016/s0003-4975(99)01091-7

Cited by 59 publications

(33 citation statements)

References 14 publications

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“…Surgical procedures, including resection of the LA appendage and cryoablation performed at sites suggested by the mapping findings, eliminated AF. 13 These investigators concluded that these relatively organized sites in the LA acted as a driver causing the AF. Sueda et al 14 performed simultaneous epicardial mapping from limited portions of the RA and LA also using a card-type electrode array, but one that consisted of 24 bipolar electrodes, in 11 patients with chronic AF and isolated mitral valve disease.…”

Section: Patterns Of Activation During Af In Humansmentioning

confidence: 99%

Epicardial Mapping of Chronic Atrial Fibrillation in Patients

et al. 2004

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Background-The mechanisms of chronic atrial fibrillation (AF) are not well understood. We performed epicardial mapping of chronic AF in patients undergoing open heart surgery to test the hypothesis that chronic AF is due to a left atrial "driver" with a regular, short cycle length, resulting in fibrillatory conduction to the rest of the atria. Methods and Results-Nine patients with chronic AF (1 month to Ͼ15 years' duration) were studied at open heart surgery, 8 before and 1 during cardiopulmonary bypass. During AF, atrial electrograms (AEGs) were recorded for 1 to 5 minutes from 404 epicardial electrodes arranged in bipoles along with ECG lead II or ventricular electrogram. Four-second segments of each bipolar AEG were also subjected to fast Fourier transform analysis. Two patterns of atrial activation were present during AF. In pattern 1 (7/9 patients), AEGs from parts of the atria demonstrated a short, regular cycle length with identical beat-to-beat morphology, and the rest of the atria were activated irregularly, and AEGs that demonstrated constant morphology and cycle length were localized to parts of the left atria (5/7), the right atria (1/7), or both atria (1/7). In pattern 2 (2/9 patients), AEGs showed no evidence of regular activation or constant morphology. Conclusions-In 9 patients with chronic AF, the commonest recorded AEG pattern showed an area of regular, rapid rhythm, consistent with the possibility that a driver causing fibrillatory conduction is one mechanism of AF in these patients.

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Section: Patterns Of Activation During Af In Humansmentioning

confidence: 99%

Epicardial Mapping of Chronic Atrial Fibrillation in Patients

et al. 2004

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“…1 Evidence of the LA "driving" fibrillation in the right atrium has been noted in optical mapping studies of isolated hearts 2 and during intraoperative mapping in patients. 3 The shortest AF cycle lengths are found in the posterior LA in dogs 4,5 and patients with chronic AF. 6 Cryoablation in the posterior LA has been shown to terminate experimentally induced AF.…”

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confidence: 95%

Role of the Posterior Left Atrium and Pulmonary Veins in Human Lone Atrial Fibrillation

et al. 2003

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Background-Surgery can eliminate atrial fibrillation (AF), but data confirming the rationale for specific lesion sets are lacking. We used postoperative electrophysiological studies to test the rationale and effects of operative pulmonary venous isolation. Methods and Results-Fourteen patients undergoing surgical pulmonary venous isolation for drug-refractory lone AF were studied. Successful isolation was confirmed postoperatively in 13 of 14 patients. Spontaneous sustained AF was recorded from the isolated pulmonary venous region (PVR) in 4 and was induced by extrastimulus testing in another.The remaining atrial region (RAR) was in sinus rhythm in 13 patients and nonsustained AF in 1. Atrial extrastimulus testing and burst pacing in the RAR failed to induce sustained AF. In follow-up, 1 patient developed paroxysmal AF, and electrical continuity between the PVR and RAR was confirmed. Isolation was achieved with radiofrequency ablation with no further AF. Another patient developed typical atrial flutter that required ablation. AF has not recurred in any patient at 25.1Ϯ11.9 months (range, 6 to 56 months) after surgery. Atrial histopathology was consistent with tachycardia-induced changes. Conclusions-Total electrical isolation of the PVR controlled AF with excellent clinical outcome and appeared necessary for success. The isolated PVR can sustain spontaneous or induced AF, whereas the considerably larger RAR does not. These data provide a sound rationale for PVR in eliminating AF. (Circulation. 2003;108:3108-3114.)

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“…Failure in application of radiofrequency in left atrium only needs additional investigation, but could be directly related to the lines of ablation, or the producer focus of arrhythmia is not in the left atrium. In 9 to 19% of the cases, the origin of arrhythmia would be the right atrium and these cases would present additional benefit with biatrial lines [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial

Breda¹,

Ragognette²,

Breda³

et al. 2010

Rev Bras Cir Cardiovasc

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Objective: The aim of this study is to evaluate the initial results of intraoperative radiofrequency ablation using biatrial procedure to treat chronic atrial fibrillation in patients with associated cardiac disease.Methods: Between February 2008 and May 2009, 15 consecutive patients were underwent mitral valve procedure plus modified radiofrequency biatrial ablation of chronic atrial fibrillation. The mean age was 47.73 ± 9.85 years and 60% were male. The mean left atrial diameter was 55.06 ± 7.56 mm.Results: There were no hospital mortality or complications related to radiofrequency ablation. The mean follow-up period was 7 ± 4 months. At the time of hospital discharge 9 (60%) patients were in sinus rhythm. After a mean follow-up period 11 (73.3%) were in sinus rhythm.Conclusion: Intraoperative biatrial radiofrequency ablation is a safe and effective technique for the treatment of chronic atrial fibrillation, with satisfactory midterms outcomes in terms of conversion to sinus rhythm. Bras Cir Cardiovasc 2010; 25(1): 45-50 Rev

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Intraoperative map guided operation for atrial fibrillation due to mitral valve disease

Cited by 59 publications

References 14 publications

Epicardial Mapping of Chronic Atrial Fibrillation in Patients

Epicardial Mapping of Chronic Atrial Fibrillation in Patients

Role of the Posterior Left Atrium and Pulmonary Veins in Human Lone Atrial Fibrillation

Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial

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