Circulation. 2003;108:1599-1604
Published online before print September 8, 2003, doi: 10.1161/01.CIR.0000091081.19465.F1
Published online before print September 8, 2003, doi: 10.1161/01.CIR.0000091081.19465.F1
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(Circulation. 2003;108:1599.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Prospective Assessment of Late Conduction Recurrence Across Radiofrequency Lesions Producing Electrical Disconnection at the Pulmonary Vein Ostium in Patients With Atrial Fibrillation
From the Arrhythmia and Electrophysiology Center, Policlinico San Donato, San Donato Milanese, Milan, Italy.
Correspondence to Riccardo Cappato, MD, Arrhythmia and Electrophysiology Center, Policlinico San Donato, vie Morandi 30, 20097 San Donato Milanese, Milan, Italy. E-mail rcappato{at}libero.it
Received March 4, 2003; de novo received May 9, 2003; revision received July 16, 2003; accepted July 17, 2003.
Background— In patients with atrial fibrillation (AF) undergoing radiofrequency (RF) electrical disconnection of multiple pulmonary veins (PVs), the incidence of late conduction recurrences has not been systematically determined.
Methods and Results— Using a prospectively designed, multistep approach, we aimed at assessing the correlation between acute achievement and chronic maintenance of electrical conduction block across RF lesions disconnecting the distal tract of the PV in 43 patients (52.3±8.2 years) with AF. Forty-one left superior (LS), 42 right superior (RS), 25 left inferior (LI), and 9 right inferior (RI) PVs were targeted during 108 EP procedures (2.6±0.5 per patient). Seventeen patients underwent 2 procedures, 23 patients underwent 3 procedures, and 3 patients underwent 4 procedures. During the first attempt, electrical disconnection was achieved in 112 PVs (95.7%). During a next procedure (time interval, 4.6±1.9 months), conduction recurrence was observed in 32 of 39 LSPVs (82.1%), 29 of 40 RSPVs (72.5%), 20 of 24 LIPVs (83.3%), and 7 of 9 RIPV (77.8%). After reablation at gap sites, a later procedure (time interval, 5.1±2.4 months) revealed a second recurrence in 13 of 22 LSPVs (59.1%) and 14 of 19 RSPVs (73.7%).
Conclusions— Conduction recurrence across disconnecting RF lesions can be observed in 
80% of cases 4 months after ablation. After reablation, similar recurrence rates are observed 5 months later. This high rate of late conduction recurrence may contribute significantly to AF recurrence in patients undergoing catheter ablation aiming at disconnection of multiple PVs.
Key Words: fibrillation • catheter ablation • electrophysiology
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 E. Valles, R. Fan, J. F. Roux, C. F. Liu, J. D. Harding, S. Dhruvakumar, M. D. Hutchinson, M. Riley, R. Bala, F. C. Garcia, et al. Localization of Atrial Fibrillation Triggers in Patients Undergoing Pulmonary Vein Isolation: Importance of the Carina Region J. Am. Coll. Cardiol., October 21, 2008; 52(17): 1413 - 1420. [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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|
|
|
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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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|
|
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|
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|
|
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|
|