Electrophysiological Breakthroughs From the Left Atrium to the Pulmonary Veins

Abstract

Background-The extent of ostial ablation necessary to electrically disconnect the pulmonary vein (PV) myocardial extensions that initiate atrial fibrillation from the left atrium has not been determined. Methods and Results-Seventy patients underwent PV mapping with a circumferential 10-electrode catheter during sinus rhythm or left atrial pacing. After assessment of perimetric distribution and activation sequence of PV potentials, ostial ablation was performed at segments showing earliest activation, with the end point of PV disconnection. A total of 162 PVs (excluding right inferior PVs) were ablated. PV potentials were present at 60% to 88% of their perimeter, but PV muscle activation was always sequential from a segment with earliest activation (breakthrough). Radiofrequency (RF) application at this breakthrough eliminated all PV potentials in 34 PVs, whereas a secondary breakthrough required RF applications at separate segments in 77; in others, Ͼ2 segments were ablated. A median of 5, 6, and 4 bipoles from the circular catheter were targeted in the right superior, left superior, and inferior PVs, respectively, to achieve PV disconnection. Early recurrence of arrhythmia was observed in 31 patients as a result of new venous or atrial foci or recovery of previously targeted PVs, most related to a single recovered breakthrough that was reablated with local RF application. Conclusions-Although PV muscle covers a large extent of the PV perimeter, there are specific breakthroughs from the left atrium that allow ostial PV disconnection by use of partial perimetric ablation.

Electroanatomic Mapping and Catheter Ablation of Breakthroughs From the Right Atrium to the Superior Vena Cava in Patients With Atrial Fibrillation

“…Before electroanatomic mapping of the SVC, all patients underwent PV isolation as previously described, 3 and induction of SVC ectopies by use of isoproterenol and atrial burst pacing was attempted. 5 SVC angiography was performed by hand injection.…”

“…[1][2][3][4][5][6] The ectopic foci in the PVs can also be treated by electrical isolation of the veins from the left atrium (LA) using RF at the LA-PV junction. 3,4 Therefore, electrophysiological and anatomic characteristics of the junctions of heart chambers and veins become important. The purpose of this study was to investigate the electrophysiological characteristics of the junction of the right atrium (RA) and SVC using electroanatomic mapping (CARTO, BiosenseWebster), as well as to determine the feasibility of the disconnection of the SVC from the RA.…”

Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

“…[1][2][3] Electrical PV isolation is the cornerstone of AF ablation, and it is well-known that the majority of recurrent atrial tachyarrhythmias result from the reconnection of PVs in patients with paroxysmal AF. 4,5 Because adenosine can reveal dormant PV conduction immediately after isolation, adenosine test has been recognized as a useful technique to predict acute PV reconnection at the index AF ablation procedure.…”

The National Heart Foundation of Australia Consensus Statement on Catheter Ablation as a Therapy for Atrial Fibrillation

“…As such, pulmonary vein ablation forms the cornerstone for AF ablation. 10 Complete electrical isolation of these structures is considered essential. This strategy is sufficient for the vast majority of patients with paroxysmal AF.…”