Circumferential mapping and electric isolation of pulmonary veins in patients with atrial fibrillation

https://doi.org/10.1016/S0002-9149(02)03102-8Get rights and content

Abstract

Information about the clinical efficacy and complications of the circumferential mapping and isolation of the pulmonary veins (PVs) in patients with atrial fibrillation (AF) is still limited. The present study included 75 patients (mean age 58 ± 11 years, 20 women) with paroxysmal (n = 69) or persistent AF (n = 6). Mapping of PVs was performed with a circumferential mapping catheter. After preferential PV–left atrium (LA) electric inputs were defined, radiofrequency ablation was performed until complete isolation of the PVs from the LA was achieved. A total of 226 PVs were mapped; 195 (86%) showed typical PV potentials. Complete isolation of PVs from the LA was achieved in 173 PVs (89%). Detailed follow-up, including 7-day Holter monitoring at 1, 4, 9, and 12 months after intervention was performed. If AF reoccurred, PVs were mapped and reisolated. After a mean follow-up period of 230 ± 133 days, 38 of 75 patients (51%) were in sinus rhythm. At 1, 4, and 9 months of follow-up, 31 of 65 patients (48%), 36 of 53 patients (68%, p = 0.04 as compared with the first month), and 21 of 28 patients (75%, p = 0.025 as compared with the first month), respectively, were in sinus rhythm. During follow-up, 30 patients (40%) underwent a second ablation procedure due to recurrence. Recurrences were related to resumption of PV muscle–left atrial conduction (27 patients) and/or extra PV foci (12 patients) or nonablated PVs (8 patients). Complications occurred in 17 patients (22%). PV stenosis was detected in 13 patients (25% to 50% in 7 patients and >50% in 6 patients). Pericardial effusion occurred in 4 patients. It was concluded that isolation of the PV from the LA is moderately effective in the prevention of AF recurrence and could be associated with serious acute and long-term complications.

Section snippets

Patient characteristics

This study included 75 consecutive patients (mean age 58 ± 11 years, 20 women) with symptomatic paroxysmal (n = 69) or persistent (n = 6) AF referred to our clinic for radiofrequency ablation between January 2001 and May 2002. Mean duration of symptomatic AF before the ablation procedure was 58 ± 68 months. Antiarrhythmic drug therapy with ≥2 antiarrythmic drugs (class I to IV) had been tried unsuccessfully. Amiodarone was used in 7 patients. AF was associated with structural heart disease in

Procedural data

Mapping of the right superior, left superior, and left inferior PV was performed in 73 patients. The right inferior PV was mapped in 7 patients. In 2 patients, PVs could not be mapped due to development of cardiac tamponade at an early stage of the procedure. Mean procedure time was 353 ± 143 minutes. Mean fluoroscopic time was 82 ± 20 minutes. Overall, 109 procedures (mean 1.45), including repeated ablations, were performed.

Mapping results

During the first ablation procedure, 226 PVs were mapped and 195 of

Discussion

The present study shows that circumferential segmental ablation was moderately effective in maintaining sinus rhythm in patients with predominantly paroxysmal AF. Thus, at 1 month of follow-up, only 31 of 65 patients remained in sinus rhythm, with 23 patients having undergone a repeated ablation procedure. The results improved after the extension of the follow-up period to 4 or 9 months. The reasons for the late improvement are unclear. Disappearance of acute trauma and the maturity of the

References (13)

  • C. Schmitt et al.

    Biatrial multisite mapping of atrial premature complexes triggering the onset of atrial fibrillation

    Am J Cardiol

    (2002)
  • M. Haissaguerre et al.

    Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins

    N Engl J Med

    (1998)
  • D.W. Cheung

    Pulmonary vein as an ectopic focus in digitalis-induced arrhythmia

    Nature

    (1981)
  • T. Saito et al.

    Left atrial myocardial extension onto pulmonary veins in humansanatomic observations relevant for atrial arrhythmias

    J Cardiovasc Electrophysiol

    (2000)
  • S.Y. Ho et al.

    Architecture of the pulmonary veinsrelevance to radiofrequency ablation

    Heart

    (2001)
  • Y.J. Chen et al.

    Effects of rapid atrial pacing on the arrhythmogenic activity of single cardiomyocytes from pulmonary veinsimplication in initiation of atrial fibrillation

    Circulation

    (2001)
There are more references available in the full text version of this article.

Cited by (0)

View full text
Copyright © 2003 Excerpta Medica Inc. All rights reserved.