Prospective Assessment of Late Conduction Recurrence Across Radiofrequency Lesions Producing Electrical Disconnection at the Pulmonary Vein Ostium in Patients With Atrial Fibrillation

Cappato, Riccardo; Negroni, Silvia; Pecora, Domenico; Bentivegna, S; Lupo, Pier Paolo; Carolei, Adriana; Esposito, Cristina; Furlanello, F; Ambroggi, L. De

doi:10.1161/01.cir.0000091081.19465.f1

Cited by 378 publications

(316 citation statements)

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Section: Pv Reconnection and Recurrent Atrial Tachyarrhythmiasmentioning

confidence: 99%

“…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. Recently, Kowalski demonstrated that PVs showing electrical reconnection after catheter-based antral ablation frequently reveal anatomic gaps or nontransmural lesions at the sites of catheter ablation, and that return of PV conduction after catheter-based isolation procedures is assumed to be attributable to failure to create permanent contiguous transmural lesions in at least part of the ablation line by histological study.…”

Section: Pv Reconnection and Recurrent Atrial Tachyarrhythmiasmentioning

confidence: 99%

“…20 Actually, even if the adenosine-provoked dormant conduction gap was eliminated at the initial procedure, PV reconduction leading to the recurrence of tachyarrhythmias was frequently observed in the repeat sessions. 4,5,15 An important multicenter randomized study (ADVICE) is currently assessing whether the elimination of dormant PV conduction will translate into a lower rate of recurrent AF. 21 …”

Section: Adenosine Test At the Index Ablation Proceduresmentioning

confidence: 99%

“…[1][2][3] Electrical PV isolation is the cornerstone of AF ablation, and it is well-known that the majority of recurrent atrial tachyarrhythmias result from the reconnection of PVs in patients with paroxysmal AF. 4,5 Because adenosine can reveal dormant PV conduction immediately after isolation, adenosine test has been recognized as a useful technique to predict acute PV reconnection at the index AF ablation procedure. [6][7][8][9][10] However, the utility of adenosine test at repeat ablation procedure undertaken for recurrent atrial tachyarrhythmias has not been reported.…”

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Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Miyazaki

Kobori

Komatsu

et al. 2012

Circ: Arrhythmia and Electrophysiology

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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.)

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Section: Pv Reconnection and Recurrent Atrial Tachyarrhythmiasmentioning

confidence: 99%

Section: Pv Reconnection and Recurrent Atrial Tachyarrhythmiasmentioning

confidence: 99%

Section: Adenosine Test At the Index Ablation Proceduresmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

Miyazaki

Kobori

Komatsu

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…This is highlighted by the observation that >90 % of patients requiring a second catheter ablation procedure demonstrate one (or more) PV reconnections (see Figure 1A). 26,45 For patients with more advanced forms of AF, recurrences may be due to the persistence of LA substrate abnormality as well as non-PV triggers (see Figure 1B). These triggers can be found in about 50 % of patients and originate in the superior vena cava, left atrial free wall or appendage, coronary sinus, crista terminalis or right atrial free wall.…”

Section: Mechanism Of Atrial Fibrillation Recurrence After Ablationmentioning

confidence: 99%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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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...

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