Nonreentrant focal activations in pulmonary veins in  canine model of sustained atrial fibrillation

Zhou, Shengmei; Chang, Chung-Pai; Wu, Tsu Juey; Miyauchi, Yasushi; Okuyama, Yuji; Park, Angela M.; Hamabe, Akira; Omichi, Chikaya; Hayashi, Hideki; Brodsky, Lauren; Mandel, William J.; Ting, Chih Tai; Fishbein, Michael C.; Karagueuzian, Hrayr S.; Chen, Peng Sheng

doi:10.1152/ajpheart.01109.2001

Cited by 89 publications

(100 citation statements)

References 37 publications

(38 reference statements)

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“…14 We simultaneously mapped the LA free wall at the junction of the left superior pulmonary vein (LSPV), the Bachmann's bundle (BB), and the lateral RA free wall ( Figure 1A). …”

Section: High-density Computerized Mapping Of Afmentioning

confidence: 99%

Altered Atrial Electrical Restitution and Heterogeneous Sympathetic Hyperinnervation in Hearts With Chronic Left Ventricular Myocardial Infarction

et al. 2003

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Background-The substrates for the increased incidence of atrial fibrillation (AF) in hearts with chronic left ventricular myocardial infarction (MI) remain poorly defined. We hypothesized that chronic MI is associated with atrial electrical and neural remodeling that enhances AF vulnerability. Methods and Results-We created MI in 8 dogs by permanent occlusion of the left anterior descending (LAD) coronary artery. Seven dogs (3 with thoracotomy) that had no LAD occlusion served as controls. Eight weeks after surgery, the incidence and duration of pacing-induced AF in the open chest anesthetized state were significantly (PϽ0.05) higher in the MI than in control dogs. Multisite biatrial monophasic action potential (MAP) recordings showed increased heterogeneity of MAP duration (MAPD) and MAPD restitution slope. AF in the MI groups was preceded by significantly higher MAPD (PϽ0.01) and MAP amplitude (PϽ0.05) alternans in both atria compared with controls. Epicardial mapping using 1792 bipolar electrodes (1-mm spatial resolution) showed multisite wavebreaks of the paced wavefronts leading to AF in MI but not in control dogs. Multiple wavelets in MI dogs were associated with significantly higher incidence and longer duration of AF compared with control. The density of biatrial tyrosine hydroxylase (TH) and growth-associated protein43 (GAP43) nerves were 5-to 8-fold higher and were more heterogeneous in MI compared with control dogs. Conclusions-Chronic

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“…14 We simultaneously mapped the LA free wall at the junction of the left superior pulmonary vein (LSPV), the Bachmann's bundle (BB), and the lateral RA free wall ( Figure 1A). …”

Section: High-density Computerized Mapping Of Afmentioning

confidence: 99%

Altered Atrial Electrical Restitution and Heterogeneous Sympathetic Hyperinnervation in Hearts With Chronic Left Ventricular Myocardial Infarction

et al. 2003

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“…21) Non-reentrant focal activations have also been reported in the PVs of a canine model of pacing-induced sustained AF. 22) These observations might partially explain the lower initial success rate of AF termination in the present study. However, our study showed a high rate of late AF termination in the chronic phase despite the failure to acutely terminate AF by RA linear ablations (Table I).…”

Section: )mentioning

confidence: 66%

Linear Catheter Ablation of the Right Atrium for Rapid Atrial Pacing-Induced Sustained Atrial Fibrillation in Dogs

et al. 2012

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SummaryCatheter ablation of persistent/long-persistent atrial fibrillation (AF) has been shown to be less effective by pulmonary vein isolation (PVI) and additional left atrial (LA) complex fractionated atrial electrograms and long linear lesions are often required. Recent reports have demonstrated right atrial (RA) ablation increases the success rate of maintaining sinus rhythm in persistent/long-persistent AF. The aim of this study was to investigate whether effective RA linear lesions can terminate AF and render it noninducible in a canine model of rapid atrial pacing-induced sustained AF. Sustained AF was induced by rapid atrial pacing in 20 dogs. AF duration was 21-126 days (median, 50 days). Four RA linear lesions (superior vena cava-inferior vena cava, septal line, transverse line, and cavo-tricuspid line) were created with the use of 1 of 3 different ablation catheters (large-tip [8-mm tip], coil-tip, and cooled-tip catheters). AF was terminated with the large-tip catheter in 4/7 dogs (1 dog died of ventricular fibrillation [VF]), with the coil-tip catheter in 3/7 dogs (1 dog died of VF), and with the cooled-tip catheter in 1/6 dogs. In 6 dogs in which AF could not be terminated acutely by RA ablation, AF terminated spontaneously at 7-78 days (median, 14 days) after ablation. RA linear ablation terminated AF with limited success in our dog model of rapid atrial pacing-induced AF, but late AF termination was noted in the surviving dogs. Therefore, RA linear lesions in addition to the PVI and LA lesions may have additional effects on the catheter ablation for the persistent AF. (Int Heart J 2012; 53: 375-382) Key words: Radiofrequency catheter ablation, Linear lesion B ecause atrial ectopic beats originating from the pulmonary veins (PVs) have been shown to initiate paroxysmal atrial fibrillation (AF), 1) PV isolation by radiofrequency (RF) ablation guided by ring catheters is widely used for the treatment of this arrhythmia.2) The single-procedure success of catheter ablation in patients with paroxysmal AF ranges from 38% to 78%, with most centers reporting an efficacy of 60% or more.3) In contrast, the single-procedure success of catheter ablation of persistent AF ranges from 22% to 45%, with most centers reporting an efficacy of 30% or less. 3)Stepwise ablation has been shown to be effective for maintenance of sinus rhythm (SR) if AF is terminated by ablation. 4)Stepwise ablation includes PV isolation, electrogram-based ablation in the left atrium, linear ablations along the left atrial (LA) roof and mitral isthmus, and right atrial (RA) ablation and is required in approximately 20% of patients with persistent AF.5) Furthermore, linear ablation of the RA guided by the electrophysiologic characteristics of paroxysmal RA-AF is an effective approach for treating certain patients with AF.6) Ablation in the RA to create linear lesions along the intercaval posterior line and intercaval septal line and electrical disconnection of the superior vena cava (SVC) have a substantially higher rate of success than ...

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“…16 The mechanisms responsible for the abnormal impulse activity have been the source of several investigations. [17][18][19][20][21][22][23] Triggered activity may be particularly important. [19][20][21][22][23] Ranolazine is an anti-anginal agent, which inhibits the normal and abnormal late Na+ channel current in the ventricle and the peak Na+ channel current in the atrium.…”

Section: 2mentioning

confidence: 99%

“…[17][18][19][20][21][22][23] Triggered activity may be particularly important. [19][20][21][22][23] Ranolazine is an anti-anginal agent, which inhibits the normal and abnormal late Na+ channel current in the ventricle and the peak Na+ channel current in the atrium. [24][25][26] By this inhibition, it affects intracellular calcium handling, producing an energy sparing effect.…”

Section: 2mentioning

confidence: 99%

The Conversion of Paroxysmal or Initial Onset Atrial Fibrillation with Oral Ranolazine: Implications for a New "Pill-In-Pocket" Approach in Structural Heart Disease

Murdock¹,

Reiffel²,

Kaliebe³

et al. 2010

J.A.F.I.B

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Background : The "Pill-in-Pocket" (PIP) is an approach to atrial fibrillation (AF) where oral anti-arrhythmics at 75% to 100% of the normal daily dose, given as a single dose, is used to convert recent-onset AF. Pro-arrhythmic risk has limited this approach to patients without structural heart disease (SHD). Ranolazine is an anti-anginal agent, which inhibits the abnormal late Na+ channel current resulting in decreased Na+/Ca++ overload. This inhibits after-depolarizations and reduces pulmonary vein firing, which have been implicated in the initiation and propagation of AF. Ranolazine increases atrial refractoriness and has no known pro-arrhythmic affects. Ranolazine is routinely given to patients with SHD. The ability of Ranolazine to terminate AF in man has not been described but if useful could be a safer PIP agent with application in the presence or absence of SHD. We describe our experience using oral Ranolazine to convert new or recurrent AF.

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Nonreentrant focal activations in pulmonary veins in canine model of sustained atrial fibrillation

Cited by 89 publications

References 37 publications

Altered Atrial Electrical Restitution and Heterogeneous Sympathetic Hyperinnervation in Hearts With Chronic Left Ventricular Myocardial Infarction

Altered Atrial Electrical Restitution and Heterogeneous Sympathetic Hyperinnervation in Hearts With Chronic Left Ventricular Myocardial Infarction

Linear Catheter Ablation of the Right Atrium for Rapid Atrial Pacing-Induced Sustained Atrial Fibrillation in Dogs

The Conversion of Paroxysmal or Initial Onset Atrial Fibrillation with Oral Ranolazine: Implications for a New "Pill-In-Pocket" Approach in Structural Heart Disease

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