Utility of Exit Block for Identifying Electrical Isolation of the Pulmonary Veins

Gerstenfeld, Edward P.; Dixit, Sanjay; Callans, David J.; Rho, Robert W.; Rajawat, Yadavendra S.; Zado, Erica S.; Marchlinski, Francis E.

doi:10.1046/j.1540-8167.2002.00971.x

Cited by 146 publications

(127 citation statements)

References 4 publications

(5 reference statements)

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“…141,142,143 Mechanistically, the most likely explanation is source–sink mismatch, which is defined as delay or block of conduction observed when the size of a given excited region supplying depolarizing current (the current source) is insufficient for the amount of depolarizing current necessary to excite the regions ahead (the current sink). 479 Although an initial report has observed unidirectional entrance block in more than 40% of PVs, 445 the incidence was much lower in more recent studies (1.5%–16%). 477,479,480,481 Interestingly, in one of these studies, the presence of PV discharges conducted to the LA (exit conduction) was followed by recovery of entrance conduction during a 30-minute waiting period.…”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 95%

“…443 The endpoint for this procedure was either amplitude reduction within the ablated area, 244,437 elimination (or dissociation) of the PV potentials recorded from either one or two circular mapping catheters, or a basket catheter within the ipsilateral PVs 435,438,439,441,442,444 and/or exit block from the PV. 445 …”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

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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

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 95%

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

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

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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1,468

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“…Ablation was performed segmentally, with isolation of those segments of the PV that demonstrated entry or exit of PV signals. Isolation was confirmed by loss of all high-frequency electrical signals on the circular mapping catheter and loss of atrial capture pacing from all overlapping bipoles of the circular mapping catheter at 10-mA, 2-ms pulse width (exit block 14 ). All PVs were revisited after at least a 20-minute waiting period, and PVs with evidence of recurrent conduction were reisolated.…”

Section: Methodsmentioning

confidence: 99%

Mechanisms of Organized Left Atrial Tachycardias Occurring After Pulmonary Vein Isolation

et al. 2004

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Background-A proarrhythmic consequence of pulmonary vein (PV) isolation can be a recurrent organized left atrial (LA) tachycardia after ablation. This arrhythmia is frequently referred to as "left atrial flutter," but the mechanism and best ablation strategy have not been determined. Methods and Results-Isolation of arrhythmogenic PVs was initially performed by segmental ostial PV ablation guided by a circular mapping catheter in 341 patients. Patients whose predominant recurrent arrhythmia was a persistent organized tachycardia returned for mapping and ablation. Recurrent organized LA tachycardias (cycle length 253Ϯ33 ms, range 213 to 328 ms) occurred in 10 (2.9%) of 341 patients (age 59Ϯ9 years, 1 woman). Mapping was consistent with a focal origin in 8 patients and with macroreentry in 1 patient and was unclear in 1 patient owing to degeneration to atrial fibrillation. Focal tachycardias originated from reconnected segments of prior isolated PVs (6 patients), the posterior LA (1 patient), or the superior septum (1 patient). Focal atrial tachycardias were ablated with point lesions that targeted the earliest activation. All reconnected PVs were also reisolated. Reentrant LA flutter occurred around the left PVs in 1 patient. After 6.7Ϯ2.3 months of follow-up, 9 (90%) of 10 patients were arrhythmia free (4 of whom were taking antiarrhythmic drug therapy), and one was having recurrent atrial fibrillation. Conclusions-Recurrent organized LA tachycardia after PV isolation is uncommon and typically has a focal origin from reconnected PV ostia. Reisolation of the PV and ablation of non-PV foci are sufficient to treat this proarrhythmia. Linear lesions are only required when a macroreentrant mechanism is present.

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“…After elimination of PV muscle conduction distal to the ablation site(s), indicated either by the abolition or dissociation of distal PVPs, the absence of conduction from the PV to LA was also confirmed by pacing inside the PV by the mapping catheter or the Lasso catheter during SR. 11,12 After electrical disconnection of the targeted PVs, provocative maneuvers (isoproterenol and burst pacing) were performed to reveal other remaining foci in the ostium proximal to the ablation sites or in other atrial tissues. Additional RF ablation was performed, targeting these remaining foci if necessary.…”

Section: Ablation Proceduresmentioning

confidence: 99%

Segmental Pulmonary Vein Antrum Isolation Using the "Large-Size" Lasso Catheter in Patients With Atrial Fibrillation

Yamane

Date

Kanzaki

et al. 2007

Circ J

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lthough the efficiency of ostial pulmonary vein isolation (OPVI) to suppress the occurrence of atrial fibrillation (AF) is well established, 1 the relatively frequent recurrence of AF 2 and the appearance of pulmonary vein (PV) stenosis 3 have recently been highlighted as major limitations of this approach. Because the isolation of the PVs, together with their surrounding tissue, might overcome these problems, at least in part, several approaches using linear ablation techniques, such as circumferential linear ablation using electroanatomical mapping 4 or circumferential 2×2 PV isolation (PVI), 5 have so far been developed; however, there have only been a few reports describing the effects of segmental radiofrequency (RF) application outside the PV ostium. 6 In this report, we describe the feasibility and efficiency of performing segmental PV antrum isolation (PVAI) using large-sized Lasso catheters compared with the conventional OPVI method. Methods Patient PopulationThis study included 187 consecutive patients who underwent PV mapping and ablation for multidrug-resistant AF (paroxysmal AF: 120 patients; persistent AF: 67 patients) and thereafter were observed for at least 12 months Circulation Journal Vol.71, May 2007 (Table 1). We defined persistent AF as an episode of AF that lasted for more than 14 days and required cardioversion to restore sinus rhythm (SR). Cases of long-lasting persistent AF for more than 12 months were not included. The study group comprised 144 males and 43 females with a mean age of 55±8 years. Forty-five patients had evidence of cardiovascular diseases: 32 had hypertension, 9 had coronary artery disease, 5 had dilated cardiomyopathy, and 3 had mitral valve regurgitation. Two types of mapping and ablation techniques were used for PVI. In Group 1, which comprised the first 70 consecutive patients (52 males, mean age: 52.0±10.3 years), each PV was disconnected from the left atrium (LA) at its ostium. In Group 2, which included the subsequent 117 patients (92 males, mean age: 53.2±9.8 years), PVI was performed at its antrum, targeting not only the PV itself but also the surrounding tissues. All patients underwent the ablation procedure and subsequent observaCirc J 2007; 71: 753 -760 (Received October 20, 2006; revised manuscript received January 24, 2007; accepted February 22, 2007 Background The limited efficacy and complications of segmental ostial pulmonary vein isolation (PVI) for treating atrial fibrillation (AF) have been discussed so, in the present study the feasibility and efficiency of performing segmental pulmonary vein (PV) antrum isolation to treat AF were assessed. Methods and Results A total of 187 patients with drug-refractory AF (paroxysmal 120, persistent 67) underwent segmental PVI guided by circumferential 20-electrode catheters (Lasso). Radiofrequency (RF) current was delivered either at the ostium using a regular Lasso (15-20 mm in diameter, 70 patients: Group 1) or at the antrum using a larger Lasso (25-30 mm in diameter, 117 patients: Group 2). A significantly ...

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Utility of Exit Block for Identifying Electrical Isolation of the Pulmonary Veins

Cited by 146 publications

References 4 publications

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

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

Mechanisms of Organized Left Atrial Tachycardias Occurring After Pulmonary Vein Isolation

Segmental Pulmonary Vein Antrum Isolation Using the "Large-Size" Lasso Catheter in Patients With Atrial Fibrillation

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