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(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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M. R.M. Jongbloed, J. J. Bax, H. J. Lamb, M. S. Dirksen, K. Zeppenfeld, E. E. van der Wall, A. de Roos, and M. J. Schalij Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation: A head-to-head comparison J. Am. Coll. Cardiol., February 1, 2005; 45(3): 343 - 350. [Abstract] [Full Text] [PDF]
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F. Gaita, R. Riccardi, D. Caponi, D. Shah, L. Garberoglio, L. Vivalda, A. Dulio, A. Chiecchio, E. Manasse, and R. Gallotti Linear Cryoablation of the Left Atrium Versus Pulmonary Vein Cryoisolation in Patients With Permanent Atrial Fibrillation and Valvular Heart Disease: Correlation of Electroanatomic Mapping and Long-Term Clinical Results Circulation, January 18, 2005; 111(2): 136 - 142. [Abstract] [Full Text] [PDF]
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P. D. Bella, S. Riva, G. Fassini, M. Casella, C. Carbucicchio, N. Trevisi, M. Berti, F. Giraldi, and G. Maccabelli Long-term follow-up after radiofrequency catheter ablation of atrial fibrillation: Role of the acute procedure outcome and of the clinical presentation Europace, January 1, 2005; 7(2): 95 - 103. [Abstract] [Full Text] [PDF]
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M. F. Scholten, A. S. Thornton, J. M. Mekel, P. J. Koudstaal, and L. J. Jordaens Anticoagulation in atrial fibrillation and flutter Europace, January 1, 2005; 7(5): 492 - 499. [Abstract] [Full Text] [PDF]
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J P Bourke, A Dunuwille, D O'Donnell, S Jamieson, and S S Furniss Pulmonary vein ablation for idiopathic atrial fibrillation: six month outcome of first procedure in 100 consecutive patients Heart, January 1, 2005; 91(1): 51 - 57. [Abstract] [Full Text] [PDF]
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L.-F. Hsu, P. Jais, P. Sanders, S. Garrigue, M. Hocini, F. Sacher, Y. Takahashi, M. Rotter, J.-L. Pasquie, C. Scavee, et al. Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure N. Engl. J. Med., December 2, 2004; 351(23): 2373 - 2383. [Abstract] [Full Text] [PDF]
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M. Tritto, R. De Ponti, J. A. Salerno-Uriarte, G. Spadacini, R. Marazzi, P. Moretti, and M. Lanzotti Adenosine restores atrio-venous conduction after apparently successful ostial isolation of the pulmonary veins Eur. Heart J., December 1, 2004; 25(23): 2155 - 2163. [Abstract] [Full Text] [PDF]
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P. Jais, M. Hocini, L.-F. Hsu, P. Sanders, C. Scavee, R. Weerasooriya, L. Macle, F. Raybaud, S. Garrigue, D. C. Shah, et al. Technique and Results of Linear Ablation at the Mitral Isthmus Circulation, November 9, 2004; 110(19): 2996 - 3002. [Abstract] [Full Text] [PDF]
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E. P. Gerstenfeld, D. J. Callans, S. Dixit, A. M. Russo, H. Nayak, D. Lin, W. Pulliam, S. Siddique, and F. E. Marchlinski Mechanisms of Organized Left Atrial Tachycardias Occurring After Pulmonary Vein Isolation Circulation, September 14, 2004; 110(11): 1351 - 1357. [Abstract] [Full Text] [PDF]
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M. Haissaguerre, P. Sanders, M. Hocini, P. Jais, and J. Clementy Pulmonary veins in the substrate for atrial fibrillation: The "venous wave" hypothesis J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2290 - 2292. [Full Text] [PDF]
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G. K. Feld Catheter ablation of atrial fibrillation: what is the best technique for achieving a high cure rate with acceptable risk? J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2054 - 2056. [Full Text] [PDF]
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M. S. Chen, N. F. Marrouche, Y. Khaykin, A. M. Gillinov, O. Wazni, D. O. Martin, A. Rossillo, A. Verma, J. Cummings, D. Erciyes, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1004 - 1009. [Abstract] [Full Text] [PDF]
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R. De Ponti, M. Tritto, M. E. Lanzotti, G. Spadacini, R. Marazzi, P. Moretti, and J. A. Salerno-Uriarte Computerized high-density mapping of the pulmonary veins: new insights into their electrical activation in patients with atrial fibrillation Europace, January 1, 2004; 6(2): 97 - 108. [Abstract] [Full Text] [PDF]
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J. O. Schwab, D. Burkhardt, A. Yang, J. Schrickel, B. Lüderitz, and T. Lewalter ECG signs mimicking acute inferior wall myocardial infarction are associated with elevated myocardial enzymes during isolation of pulmonary vein for focal atrial fibrillation Europace, January 1, 2004; 6(2): 111 - 115. [Abstract] [Full Text] [PDF]
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S. P. Thomas, G. Aggarwal, A. C. Boyd, Y. Jin, and D. L. Ross A comparison of open irrigated and non-irrigated tip catheter ablation for pulmonary vein isolation Europace, January 1, 2004; 6(4): 330 - 335. [Abstract] [Full Text] [PDF]
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J. C. Pachon M, E. I. Pachon M, J. C. Pachon M, T. J. Lobo, M. Z. Pachon, R. N. A. Vargas, D. Q. V. Pachon, F. J. Lopez M, and A. D. Jatene A new treatment for atrial fibrillation based on spectral analysis to guide the catheter RF-ablation Europace, January 1, 2004; 6(6): 590 - 601. [Abstract] [Full Text] [PDF]
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P. H. van der Voort and A. Meijer Spontaneous and induced pulmonary vein tachycardia after pulmonary vein isolation Europace, January 1, 2004; 6(6): 613 - 616. [Abstract] [Full Text] [PDF]
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E. B. Saad, A. Rossillo, C. P. Saad, D. O. Martin, M. Bhargava, D. Erciyes, D. Bash, M. Williams-Andrews, S. Beheiry, N. F. Marrouche, et al. Pulmonary Vein Stenosis After Radiofrequency Ablation of Atrial Fibrillation: Functional Characterization, Evolution, and Influence of the Ablation Strategy Circulation, December 23, 2003; 108(25): 3102 - 3107. [Abstract] [Full Text] [PDF]
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T. Arentz, J. von Rosenthal, T. Blum, J. Stockinger, G. Burkle, R. Weber, N. Jander, F. J. Neumann, and D. Kalusche Feasibility and Safety of Pulmonary Vein Isolation Using a New Mapping and Navigation System in Patients With Refractory Atrial Fibrillation Circulation, November 18, 2003; 108(20): 2484 - 2490. [Abstract] [Full Text] [PDF]
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H. Oral, C. Scharf, A. Chugh, B. Hall, P. Cheung, E. Good, S. Veerareddy, F. Pelosi Jr, and F. Morady Catheter Ablation for Paroxysmal Atrial Fibrillation: Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation Circulation, November 11, 2003; 108(19): 2355 - 2360. [Abstract] [Full Text] [PDF]
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P. M. Kistler, P. Sanders, S. P. Fynn, I. H. Stevenson, A. Hussin, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrophysiological and Electrocardiographic Characteristics of Focal Atrial Tachycardia Originating From the Pulmonary Veins: Acute and Long-Term Outcomes of Radiofrequency Ablation Circulation, October 21, 2003; 108(16): 1968 - 1975. [Abstract] [Full Text] [PDF]
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D. J. Wilber Linear ablation for atrial fibrillation: Have we come full circle? J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1283 - 1285. [Full Text] [PDF]
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R. Cappato, S. Negroni, D. Pecora, S. Bentivegna, P. P. Lupo, A. Carolei, C. Esposito, F. Furlanello, and L. De Ambroggi Prospective Assessment of Late Conduction Recurrence Across Radiofrequency Lesions Producing Electrical Disconnection at the Pulmonary Vein Ostium in Patients With Atrial Fibrillation Circulation, September 30, 2003; 108(13): 1599 - 1604. [Abstract] [Full Text] [PDF]
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R. J. Hassink, H. T. Aretz, J. Ruskin, and D. Keane Morphology of atrial myocardium in human pulmonary veins: A postmortem analysis in patients with and without atrial fibrillation J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1108 - 1114. [Abstract] [Full Text] [PDF]
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