Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy

Wang, Lin; Tai, Chih-Chien; Hsieh, Ming Hsiung

doi:10.1016/j.accreview.2003.09.033

Cited by 216 publications

(364 citation statements)

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“…The superior vena cava has also been implicated as a non-PV focus in adults and is thought to be responsible for a significant proportion of non-PV foci. 10,12 We did not find foci originating from this region in adolescents. …”

Section: Non-pv Focimentioning

confidence: 68%

“…The crista terminalis is a frequent source of atrial tachycardia in both children and adults. 9,10 The spectrum of non-PV foci in adults was well described in an extensive report by Lin et al 10 These investigators found that 28% of patients from their series had AF initiated by ectopic beats from the non-PV areas, including the LA posterior free wall (38.3%), superior vena cava (37.0%), crista terminalis (3.7%), ligament of Marshall (8.2%), coronary sinus (1.4%), and interatrial septum (1.4%). In contrast, we did not find foci in the ligament of Marshall, superior vena cava, or coronary sinus.…”

Section: Non-pv Focimentioning

confidence: 99%

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Electrophysiological Findings in Adolescents With Atrial Fibrillation Who Have Structurally Normal Hearts

et al. 2004

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Background-Atrial fibrillation (AF) is uncommon in children, and its mechanisms are unknown. This study describes the electrophysiological findings in children and adolescents with AF and the outcome of catheter ablation. Methods and Results-Nine adolescents with symptomatic, lone AF who failed antiarrhythmic drug therapy were evaluated. All patients had ECG-documented AF and underwent invasive electrophysiological testing. Intracardiac mapping was performed to determine the site of spontaneous onset of AF and rapidly firing atrial foci. Only the triggering focus was targeted for ablation or isolation. The patients' mean age was 15.9Ϯ3.3 (range, 8 to 19 years). The most common finding was rapid, irregular atrial tachycardias in the region of the pulmonary veins (nϭ5), left atrium (nϭ2), or crista terminalis (nϭ3). One patient had foci in both the pulmonary veins and crista terminalis. The cycle lengths ranged from 108 to 280 ms. Catheter ablation was acutely successful in 8 patients (88.9%), whereas 1 patient with multiple left atrium foci was treated with the surgical maze operation. Over a mean of 35Ϯ22 months, 7 patients (77.8%) were arrhythmia free on no medications, while AF recurred in 2 patients who are controlled on antiarrhythmic medications. Two patients with tachycardia-induced cardiomyopathy had resolution of their left ventricular dysfunction after ablation. Conclusions-AF in adolescents with structurally normal hearts is usually due to foci in the pulmonary veins, crista terminalis, or left atrium. These foci usually induce irregular atrial tachycardias. Catheter ablation of the foci is effective in eliminating recurrent AF.

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Section: Non-pv Focimentioning

confidence: 68%

Section: Non-pv Focimentioning

confidence: 99%

Electrophysiological Findings in Adolescents With Atrial Fibrillation Who Have Structurally Normal Hearts

et al. 2004

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“…However, the left atrial ablation technique used in this study also may have other effects that may be helpful in preventing PAF: (1) the ablation lines may eliminate anchor points for rotors or mother waves that drive AF 10,11 ; (2) the vein of Marshall, which has a left atrial insertion in close proximity to the left superior PV and which may be a source of triggers for AF, 12 may be excluded by the ablation line that encircles the left-sided PVs; (3) the ablation line that connects the 2 encircling ablation lines may eliminate sources of AF that arise on the posterior wall of the left atrium 13,14 ; and (4) Ϸ25% to 30% of the left atrial myocardium is excluded by the encircling lesions, 5 thereby limiting the area available for circulating wavelets that may be needed to perpetuate AF. 15 These effects of left atrial ablation are incremental to the effects of segmental ostial ablation and may account for the greater efficacy of left atrial ablation in eliminating PAF.…”

Section: Mechanistic Considerationsmentioning

confidence: 99%

Catheter Ablation for Paroxysmal Atrial Fibrillation

et al. 2003

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Background-Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared. Methods and Results-Of 80 consecutive patients with symptomatic PAF (age, 52Ϯ10 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left-and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 156Ϯ45 and 50Ϯ17 minutes for SOCA and 149Ϯ33 and 39Ϯ12 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of symptomatic PAF when not taking antiarrhythmic drug therapy (Pϭ0.02). Among the variables of age, sex, duration and frequency of PAF, ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size and the SOCA technique were independent predictors of recurrent PAF. The only complication was left atrial flutter in a patient who underwent LACA. Conclusions-In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA.

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“…Many cases of ectopic electrical activity originate in the pulmonary vein (2). Other sites of ectopy include the left atrial posterior wall, superior vena cava, interatrial septum, crista terminalis, and coronary sinus myocardium (3,4).…”

mentioning

confidence: 99%

Pitx2 -microRNA pathway that delimits sinoatrial node development and inhibits predisposition to atrial fibrillation

Wang¹,

Bai

Li³

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

109

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The molecular mechanisms underlying atrial fibrillation, the most common sustained cardiac arrhythmia, remain poorly understood. Genome-wide association studies uncovered a major atrial fibrillation susceptibility locus on human chromosome 4q25 in close proximity to the paired-like homeodomain transcription factor 2 (Pitx2) homeobox gene. Pitx2, a target of the left-sided Nodal signaling pathway that initiates early in development, represses the sinoatrial node program and pacemaker activity on the left side. To address the mechanisms underlying this repressive activity, we hypothesized that Pitx2 regulates microRNAs (miRs) to repress the sinoatrial node genetic program. MiRs are small noncoding RNAs that regulate gene expression posttranscriptionally. Using an integrated genomic approach, we discovered that Pitx2 positively regulates miR-17-92 and miR-106b-25. Intracardiac electrical stimulation revealed that both miR-17-92 and miR-106b-25 deficient mice exhibit pacing-induced atrial fibrillation. Furthermore electrocardiogram telemetry revealed that mice with miR-17-92 cardiac-specific inactivation develop prolonged PR intervals whereas mice with miR-17-92 cardiac-specific inactivation and miR-106b-25 heterozygosity develop sinoatrial node dysfunction. Both arrhythmias are risk factors for atrial fibrillation in humans. Importantly, miR-17-92 and miR-106b-25 directly repress genes, such as Shox2 and Tbx3, that are required for sinoatrial node development. Together, to our knowledge, these findings provide the first genetic evidence for an miR loss-of-function that increases atrial fibrillation susceptibility. irregular heart rate | single nucleotide variant | mouse genetics A trial fibrillation (AF), the most common arrhythmia in adult patients, increases in prevalence with age to almost 5% of the population over 65. Patients with AF have an increased risk of stroke, dementia, and heart failure (1). Electrical impulses that are critical for a coordinated, physiologic heartbeat originate in the sinoatrial node (SAN). In AF, abnormal fibrillatory atrial impulses override normal SAN function, with resultant irregular conduction to the ventricles. Many cases of ectopic electrical activity originate in the pulmonary vein (2). Other sites of ectopy include the left atrial posterior wall, superior vena cava, interatrial septum, crista terminalis, and coronary sinus myocardium (3, 4).Multiple approaches have been used to uncover genes that may contribute to the AF phenotype in adult patients. A seminal genome-wide association study (GWAS), subsequently replicated by multiple studies, uncovered a single nucleotide variant (SNV) on human 4q25 that was strongly associated with familial AF (5). Patients with the 4q25 variant exhibited early onset AF that was independent from other risk factors such as hypertension and diabetes, suggesting a novel biologic mechanism involving genes located on chromosome 4q25. The presence of the 4q25 SNV also had prognostic value because patients with the SNV are prone to cardioembolic str...

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Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy

Cited by 216 publications

References 0 publications

Electrophysiological Findings in Adolescents With Atrial Fibrillation Who Have Structurally Normal Hearts

Electrophysiological Findings in Adolescents With Atrial Fibrillation Who Have Structurally Normal Hearts

Catheter Ablation for Paroxysmal Atrial Fibrillation

Pitx2 -microRNA pathway that delimits sinoatrial node development and inhibits predisposition to atrial fibrillation

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