Correlative Anatomy for the Electrophysiologist: Ablation for Atrial Fibrillation. Part I: Pulmonary Vein Ostia, Superior Vena Cava, Vein of Marshall

Macedo, Paula; Kapa, Suraj; Mears, Alison; Fratianni, Amy; Asirvatham, Samuel J.

doi:10.1111/j.1540-8167.2010.01728.x

Cited by 37 publications

(28 citation statements)

References 63 publications

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“…17, 18 Similar to extensions of left atrial muscle into PV, right atrial muscle extends into SVC. 5, 6 Chen et al 18 previously described in canine SVC cardiomyocytes, the presence of spontaneously beating APs displaying phase 4 depolarization. The results of our study demonstrate a marked diversity of action potential characteristics in the canine SVC sleeve, including action potentials with short and long durations, with and without phase 4 depolarization.…”

Section: Discussionmentioning

confidence: 99%

“…6–8 Like in PV sleeves, atrial myocardial tissue has been demonstrated to extend into the SVC sleeves for approximately 2–5 cm. 5, 6 Extrasystolic activity arising from non-PV atrial structures, such as SVC, may compromise the success of PV isolation for the treatment of AF. 7 In addition to PV isolation, SVC isolation improves the outcome of AF ablation in patients with paroxysmal AF.…”

Section: Introductionmentioning

confidence: 99%

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Electrophysiological Characteristics of Canine Superior Vena Cava Sleeve Preparations

Sicouri

Blazek²,

Belardinelli³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background In addition to extrasystoles of pulmonary vein (PV) origin, those arising from the superior vena cava (SVC) can precipitate atrial fibrillation (AF). The present study evaluates the electrophysiological properties of canine SVC sleeve preparations and the effect of ranolazine on late phase 3 early and delayed afterdepolarization (EAD and DAD)-induced triggered activity in SVC sleeves, and compares SVC and PV sleeve electrophysiologic properties. Methods and Results Action potentials (APs) were recorded from superfused SVC and PV sleeves using microelectrode techniques. Acetylcholine (1 μM), isoproterenol (1 μM), high calcium ([Ca2+]o=5.4 mM), or a combination were used to induce EADs, DADs and triggered activity. A marked diversity of action potential characteristics was observed in the SVC sleeve, including action potentials with short and long APs, with and without phase 4 depolarization. Rapid pacing induced hyperpolarization, accentuating the slope of phase 4 depolarization. Phase 4 depolarization and rapid pacing-induced hyperpolarization were reduced or eliminated following atropine (10 μM) or ranolazine (10 μM). APs displaying phase 4 depolarization (n=19) had longer APDs, smaller amplitude and Vmax, and a more positive take-off potential than APs lacking phase 4 depolarization (n=15). Ranolazine (5–10 μM) eliminated late phase 3 EADs and DAD-induced triggered activity as well as isoproterenol-induced automaticity elicited in SVC sleeves. Compared to PV, SVC sleeves display phase 4 depolarization, smaller Vmax and longer APs. Conclusions Autonomic influences promote spontaneous automaticity and triggered activity in SVC sleeves, thus generating extrasystolic activity capable of initiating atrial arrhythmias. Ranolazine can effectively suppress these triggers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electrophysiological Characteristics of Canine Superior Vena Cava Sleeve Preparations

Sicouri

Blazek²,

Belardinelli³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…16 -21 Additionally, the role of venous structures, such as the coronary sinus and the Marshall bundle and vein, during AF RF ablation has been studied extensively. [25][26][27][28] The present work was not designed to evaluate the effects of RF near atrial arteries and limits itself to describing their presence at AF ablation sites. Nonetheless, on the basis of the existing data, it is plausible to suppose that interactions likely occur between the RF application on the endocardial surface and the subjacent artery on the subepicardial surface because of the relatively small thickness of the atrial wall.…”

Section: Discussionmentioning

confidence: 99%

Atrial Coronary Arteries in Areas Involved in Atrial Fibrillation Catheter Ablation

Meo

Scanavacca

Sosa

et al. 2010

Circ: Arrhythmia and Electrophysiology

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Background-The proximity to vascular structures is a limiting factor during radiofrequency ablation. However, little or no attention has been given to the atrial arterial circulation during the development of atrial fibrillation (AF) catheter ablation techniques. Methods and Results-We examined the atrial arterial circulation in areas involved in AF ablation in 24 heart specimens by colored resin injection and careful dissection. The sinus node artery (SNA) arose from the circumflex artery in 42% of case; proximal to the LA appendage in 29%, crossing the left atrium (LA) anterior wall; and after the LA appendage in the remaining 13%, crossing the mitral isthmus and passing close to the left pulmonary veins (PVs), the LA roof, and the right superior PV. In 58%, the SNA arose from the right coronary artery. Major arteries (Ն1 mm in external diameter) were found in the mitral isthmus in 54%, at the LA roof in 54%, and at the LA anterior wall in 29%. Around the left PV ostia, there were areas with major arteries in up to 37% (at the roof and inferior segments) and around the right PV ostia in up to 29% (at the roof segment). Conclusions-Major atrial coronary arteries, including the SNA, were commonly found in the areas involved in AF ablation and could cause difficulties in obtaining transmural lesions and electric isolation or even lead to ischemic sinus node or atrial dysfunction. (Circ Arrhythm Electrophysiol. 2010;3:600-605.)Key Words: arteries Ⅲ atrium Ⅲ catheter ablation Ⅲ anatomy Ⅲ atrial fibrillation A trial fibrillation (AF) is the most common arrhythmia in clinical practice, with an estimated prevalence of 0.4% to 1% in the general population 1,2 and rising with age to 8% in patients Ͼ80 years. 3 Its pharmacological treatment has yielded suboptimal results, leading to a search for nonpharmacological options for therapy. 4 Clinical Perspective on p 605During the development of the surgical approaches for AF ablation, knowledge of the atrial coronary artery anatomy was essential, leading to important technical modifications and better results. Recognition of the importance of the sinus node artery (SNA) and its relationship to the areas of atrial surgical incisions contributed to refinement in surgical technique with the maze III procedure, 5 reducing sinus node and atrial dysfunction commonly found after the initial maze I surgery. Later studies with the atrial coronary anatomy in dogs led to the proposal of the radial incisions technique, 6 reducing even further the mechanic dysfunction observed during the follow-up of patients submitted to the initial techniques. 7 The earliest techniques of radiofrequency (RF) catheter ablation simulated the surgical maze procedure 8 or attempted to eliminate ectopic foci inside the pulmonary veins (PVs). 9 In more recent modifications, endocardial RF pulses are delivered circumferentially around the PV antrum to obtain electric isolation 10,11 associated with linear ablations in the left atrium (LA) and mitral isthmus in selected patients. 12 Despite the atrial coronar...

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“…The specific risks of AF ablation reflect potentially extensive ablation as well as the proximity of atria to adnexae such as the esophagus, phrenic nerves and other vasculature 105, 106 . Awareness of these risks has improved procedural technique, e.g.…”

Section: Complications Of Af Ablationmentioning

confidence: 99%

Ablation of atrial fibrillation

Wright

Narayan

2015

Trends in Cardiovascular Medicine

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Ablation is increasingly used to treat AF, since recent trials of pharmacological therapy for AF have been disappointing. Ablation has been shown to improve maintenance of sinus rhythm compared to pharmacological therapy in many multi center trials, although success rates remain suboptimal. This review will discuss several trends in the field of catheter ablation, including studies to advance our understanding of AF mechanisms in different patient populations, innovations in detecting and classifying AF, use of this information to improve strategies for ablation, technical innovations that have improved the ease and safety of ablation, and novel approaches to surgical therapy and imaging. These trends are likely to further improve results from AF ablation in coming years as it becomes an increasingly important therapeutic option for many patients.

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Correlative Anatomy for the Electrophysiologist: Ablation for Atrial Fibrillation. Part I: Pulmonary Vein Ostia, Superior Vena Cava, Vein of Marshall

Cited by 37 publications

References 63 publications

Electrophysiological Characteristics of Canine Superior Vena Cava Sleeve Preparations

Electrophysiological Characteristics of Canine Superior Vena Cava Sleeve Preparations

Atrial Coronary Arteries in Areas Involved in Atrial Fibrillation Catheter Ablation

Ablation of atrial fibrillation

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