The distance between the vein and lesions predicts the requirement of carina ablation in circumferential pulmonary vein isolation

Lin, Yenn Jiang; Tsao, Hsuan Ming; Chang, Shih Lin; Lo, Li Wei; Tuan, Ta Chuan; Hu, Yu Feng; Tsai, Wen‐Liang; Chang, Chien Jung; Tai, Ching Tai; Suenari, Kazuyoshi; Huang, Shih-Horng; Wu, Tsu Juey; Chen, Shih Ann

doi:10.1093/europace/euq500

Cited by 45 publications

(54 citation statements)

References 21 publications

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“…[6][7][8] The reported recurrence rate after PVAI varies depending on the type of AF, the concept of lesion, the experience of the operator, the type of technical equipment, and the quality of the follow-up. However, data concerning the impact of the isolated surface area (ISA) on ablation success are limited, 9 especially after PVAI using the pace-and-ablate technique. The concept of this technique is to allow the physician to easily create long left atrium ablation lines and detect residual lesion gaps.…”

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confidence: 99%

Quantitative Analysis of Isolation Area and Rhythm Outcome in Patients With Paroxysmal Atrial Fibrillation After Circumferential Pulmonary Vein Antrum Isolation Using the Pace-and-Ablate Technique

Kiuchi

Kircher

Watanabe

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-We sought to determine the relationship between the size of the left atrial isolated surface area (ISA) after pulmonary vein antrum isolation for paroxysmal atrial fibrillation (AF) and rhythm outcome during a 12-month follow-up. Methods and Results-One hundred one consecutive patients with paroxysmal AF (mean age, 59±11 years; median [range] AF history, 36 months; mean left atrial size, 42±6 mm) were enrolled. The ISA was defined as the ratio of the total isolated antral surface area excluding the pulmonary veins to the sum of the total isolated antral surface area and the left atrial posterior wall surface area, while considering the individual characteristics of antral anatomy. All surface areas were assessed using the NavX system. Patients were divided into 4 groups according to ISA (group I: <50%; group II: 50 to <60%; group III: 60 to <70%; group IV: ≥70%). The average ISA for all patients was 59.2±11.6%. Subgroup analysis showed that ISA was 42.8±4.2% in group I (n=23), 54.2±3.0% in group II (n=23), 64.3±3.0% in group III (n=33), and 73.9±3.6% in group IV (n=22). After a 12-month follow-up period, 70% of patients in group I, 78% in group II, 97% in group III, and 100% in group IV were free from AF and atrial macroreentrant tachycardia. There was a significant difference between groups I and III, I and IV, II and III, and II and IV but not groups I and II and groups III and IV (logrank test P=0.024, 0.016, 0.037, 0.044, 0.584, and 0.500, respectively). Receiver operating characteristic curve analysis yielded an optimal cutoff value of 55% for ISA. Conclusions-After Methods Patient SelectionThe study was conducted on 101 consecutive patients with highly symptomatic, medically refractory paroxysmal AF, who had been treated with PVAI between January and December 2009. Paroxysmal AF was defined as a self-terminating AF of <1 week duration. Mapping and Ablation ProcedureBefore the procedure, transesophageal echocardiography was performed to exclude thrombus formation. Patients were studied under deep propofol sedation, breathing spontaneously. Standard electrode catheters were placed in the right ventricular apex and the coronary sinus, after which a single transseptal puncture was made. Unfractionated heparin was administered in bolus form immediately after the transseptal puncture to maintain an activated clotting time of >250 s. If AF occurred an external electrical cardioversion was performed to restore sinus rhythm. Mapping and ablation were performed using the NavX system (St. Jude Medical, Inc, St. Paul, MI) as a guide after integration of a 3-dimensional model of the left atrium (LA) and PV anatomy obtained from preinterventional computed tomography (CT), as described previously. 10 Before the ablation, the circular mapping catheter-reconstructed PV anatomies were aligned with the CT-PVs. Furthermore, the multipolar mapping catheter was replaced by a 4-mm M-curve irrigated tip ablation catheter (IBI Therapy Cooled Path; St Jude Medical, Inc). Fine adjustment of image integration was ach...

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confidence: 99%

Quantitative Analysis of Isolation Area and Rhythm Outcome in Patients With Paroxysmal Atrial Fibrillation After Circumferential Pulmonary Vein Antrum Isolation Using the Pace-and-Ablate Technique

Kiuchi

Kircher

Watanabe

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…Left atrium-PV connection sites electrogram were characterized by multi-component electrograms during sinus rhythm, and could last longer than 50 ms, possibly due to local anisotropic conduction [31,32]. According to this observation, we can speculate the beneficial effect of identification of complex, fractionated, and prolonged electrograms in the PV ostium may facilitate the conduction isthmuses into the PV to achieve the endpoint of complete electric isolation [31,32].…”

Section: Electroanatomic Mappingmentioning

confidence: 87%

Mapping of the Atrial Electrogram in Sinus Rhythm and Different Atrial Fibrillation Substrates

Lin

Chang

et al. 2012

Cardiac Mapping

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“…The details of the electrophysiological study and the 3-D mapping of AF were described in our previous work [10][11][12][13][14][15][16]. Briefly, each patient underwent an electrophysiological study and catheter ablation while in the fasting, non-sedated state.…”

Section: Electrophysiological Study and 3-dimensional (3-d) Mapping Smentioning

confidence: 99%

“…The signal from the roving catheter was used to build a sequential map. After constructing the sequential map, the bipolar mapping points were collected and analyzed using an offline software [10][11][12][13][14][15][16].…”

Section: Electrophysiological Study and 3-dimensional (3-d) Mapping Smentioning

confidence: 99%

The clinical and electroanatomical characteristics of paroxysmal lone atrial fibrillation

Tuan

Chang

Lin

et al. 2012

Journal of Arrhythmia

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a b s t r a c tIntroduction: Lone atrial fibrillation (AF) is defined as AF occurring in the absence of any other cardiovascular disease. The prognosis of patients with lone AF varies in previous studies, and the clinical and electroanatomical characteristics of lone AF are unclear. The purpose of this study was to investigate the clinical characteristics of lone AF. Methods: This study included 203 patients (52 7 13 years old, 144 males) that underwent circumferential pulmonary vein isolation (CPVI) for paroxysmal AF. The mean voltage and total activation time of the individual atria were obtained by using a NavX mapping system and were compared for patients with lone and non-lone AF. Several parameters, including the age, gender, AF duration, and left atrial (LA) diameter were analyzed. Results: Compared with non-lone AF patients, lone AF patients were significantly younger (49 7 13 years old vs. 58 7 11 years old, p o0.001) and had lower body-mass index (BMI, 24.60 7 2.96 vs. 26.07 73.29, p¼ 0.02), lesser cholesterol level (169.06 731.41 vs. 183.63 731.12, p¼ 0.014), smaller LA diameter (35.89 7 4.90 vs. 40.86 7 4.62, p o0.001), and higher LA bipolar voltage (2.10 70.50 vs. 1.83 7 0.73 mV, p o 0.05). Furthermore, a dramatic voltage reduction was observed for 60-year-old patients. Conclusion: Patients with lone AF have unique clinical and electroanatomical characteristics.

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The distance between the vein and lesions predicts the requirement of carina ablation in circumferential pulmonary vein isolation

Abstract: This study indicated the importance of complete linear lesions and additional carina ablation when the wide area circumferential PV isolation was applied.

Cited by 45 publications

References 21 publications

Quantitative Analysis of Isolation Area and Rhythm Outcome in Patients With Paroxysmal Atrial Fibrillation After Circumferential Pulmonary Vein Antrum Isolation Using the Pace-and-Ablate Technique

Quantitative Analysis of Isolation Area and Rhythm Outcome in Patients With Paroxysmal Atrial Fibrillation After Circumferential Pulmonary Vein Antrum Isolation Using the Pace-and-Ablate Technique

Mapping of the Atrial Electrogram in Sinus Rhythm and Different Atrial Fibrillation Substrates

The clinical and electroanatomical characteristics of paroxysmal lone atrial fibrillation

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