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(Circulation. 1997;95:572-576.)
© 1997 American Heart Association, Inc.
Articles |
A Focal Source of Atrial Fibrillation Treated by Discrete Radiofrequency Ablation
the Hopital Cardiologique du Haut-Leveque, Bordeaux-Pessac, France.
Correspondence to Dr Pierre Jais, Hopital Cardiologique du Haut-Leveque, Ave de Magellan, 33604 Bordeaux-Pessac, France.
Background Atrial fibrillation is usually thought to be due to multiple circulating reentrant wavelets. From previous studies, a focal mechanism is considered to be very unlikely. In this report, focal atrial fibrillation is defined on an ECG pattern of atrial fibrillation and later demonstrated to be due to a focal source.
Methods and Results Nine patients (five men and four women; age, 38±7 years) with paroxysmal focal atrial fibrillation are reported here. All were free of structural heart disease and had frequent episodes of atrial fibrillation despite the use of a mean of 4±2 antiarrhythmic drugs. Atrial fibrillation was associated with runs of irregular atrial tachycardia or monomorphic extrasystoles. The electrophysiological study demonstrated that all the atrial arrhythmias were due to the same focus firing irregularly and exhibiting a consistent and centrifugal pattern of activation. Three foci were found to be located in the right atrium, two near the sinus node and one in the ostium of the coronary sinus. Six others were located in the left atrium at the ostium of the right pulmonary veins (n=5) and at the ostium of the left superior pulmonary vein (n=1). All atrial arrhythmias were successfully treated by use of a mean of 4±4 radiofrequency pulses.
Conclusions In some patients, the surface ECG pattern of atrial fibrillation is due to a focal rapidly firing source of activity that can be eliminated by discrete radiofrequency energy applications.
Key Words: fibrillation • catheter ablation • tachycardia • arrhythmia
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P. Jais, D.C. Shah, M. Hocini, L. Macle, K.-J. Choi, M. Haissaguerre, and J. Clementy Radiofrequency ablation for atrial fibrillation Eur. Heart J. Suppl., September 1, 2003; 5(suppl_H): H34 - H39. [Abstract] [PDF]
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G. Stabile, P. Turco, V. La Rocca, P. Nocerino, E. Stabile, and A. De Simone Is Pulmonary Vein Isolation Necessary for Curing Atrial Fibrillation? Circulation, August 12, 2003; 108(6): 657 - 660. [Abstract] [Full Text] [PDF]
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J. Kalifa, J. Jalife, A. V. Zaitsev, S. Bagwe, M. Warren, J. Moreno, O. Berenfeld, and S. Nattel Intra-Atrial Pressure Increases Rate and Organization of Waves Emanating From the Superior Pulmonary Veins During Atrial Fibrillation Circulation, August 12, 2003; 108(6): 668 - 671. [Abstract] [Full Text] [PDF]
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R. Kato, L. Lickfett, G. Meininger, T. Dickfeld, R. Wu, G. Juang, P. Angkeow, J. LaCorte, D. Bluemke, R. Berger, et al. Pulmonary Vein Anatomy in Patients Undergoing Catheter Ablation of Atrial Fibrillation: Lessons Learned by Use of Magnetic Resonance Imaging Circulation, April 22, 2003; 107(15): 2004 - 2010. [Abstract] [Full Text] [PDF]
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H. Honjo, M. R. Boyett, R. Niwa, S. Inada, M. Yamamoto, K. Mitsui, T. Horiuchi, N. Shibata, K. Kamiya, and I. Kodama Pacing-Induced Spontaneous Activity in Myocardial Sleeves of Pulmonary Veins After Treatment With Ryanodine Circulation, April 15, 2003; 107(14): 1937 - 1943. [Abstract] [Full Text] [PDF]
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A. Hamabe, Y. Okuyama, Y. Miyauchi, S. Zhou, H.-N. Pak, H. S. Karagueuzian, M. C. Fishbein, and P.-S. Chen Correlation Between Anatomy and Electrical Activation in Canine Pulmonary Veins Circulation, March 25, 2003; 107(11): 1550 - 1555. [Abstract] [Full Text] [PDF]
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B. Gorenek, G. Kudaiberdieva, O. Goktekin, Y. Cavusoglu, A. Birdane, A. Unalir, N. Ata, and B. Timuralp Long-short sequence may predict immediate recurrence of atrial fibrillation after external cardioversion Europace, January 1, 2003; 5(1): 11 - 16. [Abstract] [PDF]
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S. Levy, A. J. Camm, S. Saksena, E. Aliot, G. Breithardt, H. Crijns, W. Davies, N. Kay, E. Prystowsky, R. Sutton, et al. International consensus on nomenclature and classification of atrial fibrillation: A collaborative project of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Europace, January 1, 2003; 5(2): 119 - 122. [PDF]
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I. F. Lozano, A. Vincent, J. Roda, M. Méndez, J. M. M. Ferrer, F. Andrade, J. J. Manzano, R. Ceres, J. Errejon, and J. Toquero Paroxysmal atrial fibrillation prevention by pacing in patients with pacemaker indication Europace, January 1, 2003; 5(3): 267 - 273. [Abstract] [Full Text] [PDF]
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P. Jais, M. Hocini, L. Macle, K.-J. Choi, I. Deisenhofer, R. Weerasooriya, D. C. Shah, S. Garrigue, F. Raybaud, C. Scavee, et al. Distinctive Electrophysiological Properties of Pulmonary Veins in Patients With Atrial Fibrillation Circulation, November 5, 2002; 106(19): 2479 - 2485. [Abstract] [Full Text] [PDF]
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S. Verheule, E. E Wilson, R. Arora, S. K Engle, L. R Scott, and J. E Olgin Tissue structure and connexin expression of canine pulmonary veins Cardiovasc Res, September 1, 2002; 55(4): 727 - 738. [Abstract] [Full Text] [PDF]
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I. Mirza, S. James, and P. Holt Biatrial pacing for paroxysmal atrial fibrillation: A randomized prospective study into the suppression of paroxysmal atrial fibrillation using biatrial pacing J. Am. Coll. Cardiol., August 7, 2002; 40(3): 457 - 463. [Abstract] [Full Text] [PDF]
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J. M. Mangrum, J. P. Mounsey, L. C. Kok, J. P. DiMarco, and D. E. Haines intracardiac echocardiography-guided, anatomically based radiofrequency ablation of focal atrial fibrillation originating from pulmonary veins J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1964 - 1972. [Abstract] [Full Text] [PDF]
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M. Bettoni and M. Zimmermann Autonomic Tone Variations Before the Onset of Paroxysmal Atrial Fibrillation Circulation, June 11, 2002; 105(23): 2753 - 2759. [Abstract] [Full Text] [PDF]
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J. Kneller, R. Zou, E. J. Vigmond, Z. Wang, L. J. Leon, and S. Nattel Cholinergic Atrial Fibrillation in a Computer Model of a Two-Dimensional Sheet of Canine Atrial Cells With Realistic Ionic Properties Circ. Res., May 17, 2002; 90 (9): e73 - e87. [Abstract] [Full Text] [PDF]
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T. Deneke, K. Khargi, P. H. Grewe, S. von Dryander, F. Kuschkowitz, T. Lawo, K.-M. Muller, A. Laczkovics, and B. Lemke Left atrial versus bi-atrial maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery: Safety and efficacy J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1644 - 1650. [Abstract] [Full Text] [PDF]
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J. M.T. de Bakker, S. Y. Ho, and M. Hocini Basic and clinical electrophysiology of pulmonary vein ectopy Cardiovasc Res, May 1, 2002; 54(2): 287 - 294. [Abstract] [Full Text] [PDF]
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P.-S. Chen, T.-J. Wu, C. Hwang, S. Zhou, Y. Okuyama, A. Hamabe, Y. Miyauchi, C.-M. Chang, L. S. Chen, M. C. Fishbein, et al. Thoracic veins and the mechanisms of non-paroxysmal atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 295 - 301. [Abstract] [Full Text] [PDF]
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A. Shimizu and O. A. Centurion Electrophysiological properties of the human atrium in atrial fibrillation Cardiovasc Res, May 1, 2002; 54(2): 302 - 314. [Abstract] [Full Text] [PDF]
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P. Jais, R. Weerasooriya, D. C. Shah, M. Hocini, L. Macle, K.-J. Choi, C. Scavee, M. Haissaguerre, and J. Clementy Ablation therapy for atrial fibrillation (AF): Past, present and future Cardiovasc Res, May 1, 2002; 54(2): 337 - 346. [Abstract] [Full Text] [PDF]
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T Deneke, K Khargi, P.H Grewe, A Laczkovics, S von Dryander, T Lawo, K.-M Muller, and B Lemke Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial Eur. Heart J., April 1, 2002; 23(7): 558 - 566. [Abstract] [Full Text] [PDF]
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S. Lonnerholm, P. Blomstrom, L. Nilsson, and C. Blomstrom-Lundqvist Atrial size and transport function after the Maze III procedure for paroxysmal atrial fibrillation Ann. Thorac. Surg., January 1, 2002; 73(1): 107 - 111. [Abstract] [Full Text] [PDF]
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D C Shah, M Haissaguerre, and P Jais Current perspectives on curative catheter ablation of atrial fibrillation Heart, January 1, 2002; 87(1): 6 - 8. [Full Text] [PDF]
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P. Adragao, D. Cavaco, C. Aguiar, J. Palos, F. Morgado, R. Ribeiras, M. Abecasis, J. Neves, D. Bonhorst, and R. Seabra-Gomes Ablation of pulmonary vein foci for the treatment of atrial fibrillation. Percutaneous electroanatomical guided approach Europace, January 1, 2002; 4(4): 391 - 399. [Abstract] [PDF]
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R. E. Ideker, J. Huang, V. Fast, and W. M. Smith Recent Fibrillation Studies: Attempts to Wrest Order From Disorder Circ. Res., December 7, 2001; 89(12): 1089 - 1091. [Full Text] [PDF]
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K. Tanaka, S. Satake, S. Saito, S. Takahashi, Y. Hiroe, Y. Miyashita, S. Tanaka, M. Tanaka, and Y. Watanabe A new radiofrequency thermal balloon catheter for pulmonary vein isolation J. Am. Coll. Cardiol., December 1, 2001; 38(7): 2079 - 2086. [Abstract] [Full Text] [PDF]
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H. Calkins Progress continues in the quest to cure atrial fibrillation with catheter ablation techniques Eur. Heart J., November 2, 2001; 22(22): 2038 - 2040. [PDF]
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A. Capucci, G.Q. Villani, N. Marrazzo, and M. Piepoli The complementary role of drug, ablation and device in the electrical therapy of atrial fibrillation Eur. Heart J. Suppl., November 1, 2001; 3(suppl_P): P47 - P52. [Abstract] [PDF]
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