Segmental Ostial Ablation to Isolate the Pulmonary Veins During Atrial Fibrillation

Abstract

Segmental ostial ablation guided by PV tachycardia during AF is feasible and as efficacious as during sinus rhythm. The responses to cardioversion, ablation, and rapid pacing observed in this study imply that IRAF is triggered by the PVs and that PV tachycardias may play an important role in the perpetuation of AF.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…434,435 Ablation at these sites was either performed segmentally, guided by a circular mapping catheter 433,436 positioned close to the PV ostium, the so-called segmental PV ablation, or by wider continuous circumferential ablation lesions created to surround the right or left PVs, 244,432 the so-called wide-area circumferential ablation (WACA). The circumferential ablation or isolation line was either guided by 3D EAM, 244,437,438 by fluoroscopy, 439 or by intracardiac echocardiography (ICE).…”

“…253,329,436,684,932,935,970,971,972 Because these arrhythmias do not definitively indicate therapy failure over the long term (only half of these patients will manifest later recurrences), this period is also referred to as the blanking or therapy stabilization period. 935,973 It is also important to recognize that the later AF recurrences are observed during the blanking phase, the lower the chance of long-term success.…”

“…253,436,507,508,622,623, 624,625,630,870,871,995,996,997,998,999,1000,1001,1002 Most of these tachycardias originate in the LA, although RA cavotricuspid isthmus (CTI)-dependent flutters might also occur. Patients with a regular AT of new onset might complain of worsening symptoms due to a faster mean ventricular rate (frequently 2:1 ventricular response) than that during AF preablation.…”

“…253,254,255,436 Whether this is due to an early “inflammatory” response in the atrium or pericardium remains hypothetical. Based on these observations, prior consensus statements, and the present consensus document, the writing group recommends the use of a 3-month blanking period immediately postablation, during which arrhythmia recurrences are not counted toward the primary recurrence endpoint (Table 10).…”

Atrial Electroanatomical Remodeling as a Determinant of Different Outcomes Between Two Current Ablation Strategies: Circumferential Pulmonary Vein Isolation Vs Pulmonary Vein Isolation

“…1,2 Pulmonary vein isolation (PVI) based on isolation of the arrhythmogenic PVs from the left atrium (LA) has been shown to cure AF. 2,3 However, it has recently been reported that circumferential LA ablation is more effective in eliminating AF than PVI.…”