on August 12, 2002
Published online before print August 12, 2002, doi: 10.1161/01.CIR.0000027821.55835.00
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on April 15, 2002
From the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor. * To whom correspondence should be addressed. E-mail: oralh{at}umich.edu.
Background—The purpose of this study was to determine the feasibility and mechanistic implications of segmental pulmonary vein (PV) ostial ablation during atrial fibrillation (AF). Methods and Results—Forty consecutive patients underwent PV isolation for AF. Among 125 PVs targeted for isolation, ablation was performed during AF in 70 veins and during sinus rhythm in 55 veins. A decapolar Lasso catheter was positioned near the ostium. During AF, ostial ablation was performed near the Lasso catheter electrodes that recorded a tachycardia with a cycle length shorter than in the adjacent left atrium. During sinus rhythm, ostial ablation was guided by PV potentials. Complete PV isolation was achieved in 70 PVs (100%) ablated during AF and in 53 PVs (96%) ablated during sinus rhythm (P=0.4). The mean durations of radiofrequency energy needed for isolation were 7.4±4.4 and 5.2±3.9 minutes during AF and sinus rhythm, respectively (P<0.01). Before ablation, an immediate recurrence of AF (IRAF), occurred after cardioversion in 18 of 40 patients, and IRAF was consistently abolished by PV isolation. The probability of AF termination during isolation of a PV was directly related to the extent of tachycardia in that vein. As more PVs were isolated, induction of persistent AF by rapid pacing became less likely. Conclusions—Segmental ostial ablation guided by PV tachycardia during AF is feasible and as efficacious as during sinus rhythm. The responses to cardioversion, ablation, and rapid pacing observed in this study imply that IRAF is triggered by the PVs and that PV tachycardias may play an important role in the perpetuation of AF.
Revised on June 12, 2002
Accepted on June 12, 2002
Segmental Ostial Ablation to Isolate the Pulmonary Veins During Atrial Fibrillation. Feasibility and Mechanistic Insights
Hakan Oral MD*,
Key words: fibrillation • veins • catheter ablation
This article has been cited by other articles:
 |
|
 |
|
  J. Chen, M. K. Off, E. Solheim, P. Schuster, P. I. Hoff, and O.-J. Ohm Treatment of atrial fibrillation by silencing electrical activity in the posterior inter-pulmonary-vein atrium Europace, March 1, 2008; 10(3): 265 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Oral, A. Chugh, E. Good, A. Wimmer, S. Dey, N. Gadeela, S. Sankaran, T. Crawford, J. F. Sarrazin, M. Kuhne, et al. Radiofrequency Catheter Ablation of Chronic Atrial Fibrillation Guided by Complex Electrograms Circulation, May 22, 2007; 115(20): 2606 - 2612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oral, A. Chugh, M. Ozaydin, E. Good, J. Fortino, S. Sankaran, S. Reich, P. Igic, D. Elmouchi, D. Tschopp, et al. Risk of Thromboembolic Events After Percutaneous Left Atrial Radiofrequency Ablation of Atrial Fibrillation Circulation, August 22, 2006; 114(8): 759 - 765. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oral, A. Chugh, E. Good, S. Sankaran, S. S. Reich, P. Igic, D. Elmouchi, D. Tschopp, T. Crawford, S. Dey, et al. A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation Circulation, April 18, 2006; 113(15): 1824 - 1831. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haissaguerre, M. Hocini, P. Sanders, Y. Takahashi, M. Rotter, F. Sacher, T. Rostock, L.-F. Hsu, A. Jonsson, M. D. O'Neill, et al. Localized Sources Maintaining Atrial Fibrillation Organized by Prior Ablation Circulation, February 7, 2006; 113(5): 616 - 625. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kalifa, K. Tanaka, A. V. Zaitsev, M. Warren, R. Vaidyanathan, D. Auerbach, S. Pandit, K. L. Vikstrom, R. Ploutz-Snyder, A. Talkachou, et al. Mechanisms of Wave Fractionation at Boundaries of High-Frequency Excitation in the Posterior Left Atrium of the Isolated Sheep Heart During Atrial Fibrillation Circulation, February 7, 2006; 113(5): 626 - 633. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Ouyang, S. Ernst, J. Chun, D. Bansch, Y. Li, A. Schaumann, H. Mavrakis, X. Liu, F. T. Deger, B. Schmidt, et al. Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique Circulation, November 15, 2005; 112(20): 3038 - 3048. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Lemola, H. Oral, A. Chugh, B. Hall, P. Cheung, J. Han, K. Tamirisa, E. Good, F. Bogun, F. Pelosi Jr, et al. Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1060 - 1066. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Karch, B. Zrenner, I. Deisenhofer, J. Schreieck, G. Ndrepepa, J. Dong, K. Lamprecht, P. Barthel, E. Luciani, A. Schomig, et al. Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation: A Randomized Comparison Between 2 Current Ablation Strategies Circulation, June 7, 2005; 111(22): 2875 - 2880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T H Hauser, S B Yeon, S McClennen, G Katsimaglis, K V Kissinger, M E Josephson, N M Rofsky, and W J Manning Subclinical pulmonary vein narrowing after ablation for atrial fibrillation Heart, May 1, 2005; 91(5): 672 - 673. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hocini, P. Sanders, P. Jais, L.-F. Hsu, R. Weerasoriya, C. Scavee, Y. Takahashi, M. Rotter, F. Raybaud, L. Macle, et al. Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins Eur. Heart J., April 1, 2005; 26(7): 696 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
P Jais, P Sanders, L F Hsu, M Hocini, and M Haissaguerre Catheter ablation for atrial fibrillation Heart, January 1, 2005; 91(1): 7 - 9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Sticherling, S. Behrens, W. Kamke, A. Stahn, and M. Zabel Comparison of acute and long-term effects of single-dose amiodarone and verapamil for the treatment of immediate recurrences of atrial fibrillation after transthoracic cardioversion Europace, January 1, 2005; 7(6): 546 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oral, A. Chugh, K. Lemola, P. Cheung, B. Hall, E. Good, J. Han, K. Tamirisa, F. Bogun, F. Pelosi Jr, et al. Noninducibility of Atrial Fibrillation as an End Point of Left Atrial Circumferential Ablation for Paroxysmal Atrial Fibrillation: A Randomized Study Circulation, November 2, 2004; 110(18): 2797 - 2801. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haissaguerre, P. Sanders, M. Hocini, L.-F. Hsu, D. C. Shah, C. Scavee, Y. Takahashi, M. Rotter, J.-L. Pasquie, S. Garrigue, et al. Changes in Atrial Fibrillation Cycle Length and Inducibility During Catheter Ablation and Their Relation to Outcome Circulation, June 22, 2004; 109(24): 3007 - 3013. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Scharf, S. Veerareddy, M. Ozaydin, A. Chugh, B. Hall, P. Cheung, E. Good, F. Pelosi Jr, F. Morady, and H. Oral Clinical significance of inducible atrial flutter during pulmonary vein isolation in patients with atrial fibrillation J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2057 - 2062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
D. M. Todd, A. C. Skanes, G. Guiraudon, C. Guiraudon, A. D. Krahn, R. Yee, and G. J. Klein Role of the Posterior Left Atrium and Pulmonary Veins in Human Lone Atrial Fibrillation: Electrophysiological and Pathological Data From Patients Undergoing Atrial Fibrillation Surgery Circulation, December 23, 2003; 108(25): 3108 - 3114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|