(Circulation. 2000;101:1409.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Electrophysiological End Point for Catheter Ablation of Atrial Fibrillation Initiated From Multiple Pulmonary Venous Foci
Presented in part at the 20th Annual NASPE Meeting, Toronto, Canada, May 12 to 15, 1999.
From the Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
Correspondence to Professeur Michel Haïssaguerre, Hôpital Cardiologique du Haut-Lévêque, Ave de Magellan, 33604 Bordeaux-Pessac, France.
Background—The end point for catheter ablation of pulmonary vein (PV) foci initiating atrial fibrillation (AF) has not been determined.
Methods and Results—Ninety patients underwent mapping during
spontaneous or induced ectopy and/or AF initiation. Ostial PV ablation
was performed by use of angiograms to precisely define targeted sites.
Success defined by elimination of AF without drugs was correlated with
the procedural end point of the abolition of distal PV potentials. A
total of 197 arrhythmogenic PV foci (97%)—single in 31% and multiple
in 69%—and 6 atrial foci were identified. A discrete radiofrequency
(RF) application eliminated the PV potentials in 9 PV foci, whereas 2
foci from the same PV required RF applications at separate sites in 19
cases. In others, a wider region was targeted with progressive
elimination of ectopy. In 49 patients, multiple sessions were necessary
owing to recurrent or new ectopy. The clinical success rates were 93%,
73%, and 55% in patients with 1, 2, and 
3 arrhythmogenic PV foci.
Recovery of local PV potential and the inability to abolish it were
significantly associated with AF recurrences (90% success rate
with versus 55% without PV potential abolition). PV stenosis
was noted acutely in 5 of 6 cases, remained unchanged at restudy, and
was associated with RF power >45 W.
Conclusions—Multiple PV foci are involved in initiation of AF, and elimination of PV muscle conduction is associated with clinical success.
Key Words: atrial fibrillation • catheter ablation • electrophysiology
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