Circulation. 2003;107:3176-3183
Published online before print June 23, 2003, doi: 10.1161/01.CIR.0000074206.52056.2D
Published online before print June 23, 2003, doi: 10.1161/01.CIR.0000074206.52056.2D
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(Circulation. 2003;107:3176.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Catheter Ablation of Paroxysmal Atrial Fibrillation Initiated by Non–Pulmonary Vein Ectopy
From the Division of Cardiology, Department of Medicine, National Yang-Ming University, Cardiovascular Research Institute, Taipei/Taichung Veterans General Hospital, and Division of Cardiology, Department of Internal Medicine, National Defense Medical Center and Tri-Service General Hospital (W.-S.L., S.-P.Y.), Taipei, Taiwan.
Correspondence to Shih-Ann Chen, MD, Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan. E-mail epsachen{at}ms41.hinet.net
Background— Most of the ectopic beats initiating paroxysmal atrial fibrillation (PAF) originate from the pulmonary vein (PV). However, only limited data are available on PAF originating from the non-PV areas.
Methods and Results— Two hundred forty patients with a total of 358 ectopic foci initiating PAF were included. Sixty-eight (28%) patients had AF initiated by ectopic beats (73 foci, 20%) from the non-PV areas, including the left atrial posterior free wall (28, 38.3%), superior vena cava (27, 37.0%), crista terminalis (10, 3.7%), ligament of Marshall (6, 8.2%), coronary sinus ostium (1, 1.4%), and interatrial septum (1, 1.4%). Catheter ablation eliminated AF with acute success rates of 63%, 96%, 100%, 50%, 100%, and 0% in left atrial posterior free wall, superior vena cava, crista terminalis, ligament of Marshall, coronary sinus ostium, and interatrial septum, respectively. During a follow-up period of 22±11 months, 43 patients (63.2%) were free of antiarrhythmic drugs without AF recurrence.
Conclusions— Ectopic beats initiating PAF can originate from the non-PV areas, and catheter ablation of the non-PV ectopy has a moderate efficacy in treatment of PAF.
Key Words: atrial fibrillation • ablation • pulmonary vein
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 |
|
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
Y.-J. Lin, C.-T. Tai, T. Kao, H.-W. Tso, J.-L. Huang, S. Higa, Y. Yuniadi, B.-H. Huang, T.-Y. Liu, P.-C. Lee, et al. Electrophysiological Characteristics and Catheter Ablation in Patients With Paroxysmal Right Atrial Fibrillation Circulation, September 20, 2005; 112(12): 1692 - 1700. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 T. Nitta, H. Ohmori, S.-i. Sakamoto, Y. Miyagi, S. Kanno, and K. Shimizu Map-guided surgery for atrial fibrillation J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 291 - 299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
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|
|
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|
|
|
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|
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