Localization of Atrial Fibrillation Triggers in Patients Undergoing Pulmonary Vein Isolation

: Pulmonary vein isolation using radiofrequency energy is performed extensively to treat symptomatic, drug-refractory atrial brillation. However, anatomical knowledge of the left atrial wall surrounding the pulmonary vein PV openings is insuf cient to create an ablation line. Using autopsy hearts from 23 individuals median age of 63 years , we studied the histological nature of anatomical obstacles or related isthmuses near the PV openings. None of the individuals had a history of tachyarrhythmia or other major cardiac abnormalities. After macroscopic measurement of the minimum width of each isthmus, the following areas were excised and histologically prepared: atrial roof-mitral valve annulus MVA , left superior pulmonary vein LSPV -left atrial appendage LAA , LAA-MVA, left inferior pulmonary vein LIPV -MVA, right superior pulmonary vein RSPV -fossa ovalis FO , right inferior pulmonary vein RIPV -FO, and FO-MVA. Within the obstacles near the PV openings, the LSPV-LAA isthmus was found to be the narrowest, whereas the LIPV-MVA was the widest and thickest isthmus. Histological complexity of each isthmus was determined, and the compound architecture of the myocardium was revealed. The further presence of a variety of nerve endings as well as myocardial blood supply enhanced the tissue diversity. Such an insight into the diversity of myocardial architecture or histological complexity in each isthmus might be helpful in creating a reliable ablation line in pulmonary vein isolation procedures.

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“…Particularly, the mid-PV opening may enhance tissue non-uniformity in the carina of right PV openings 3 .…”

Section: Discussionmentioning

confidence: 99%

“…One possible mechanism underlying the recurrence may be the reconnection of ablated atrial musculature surrounding the PV openings 3 . In addition to the technical challenges, the tissue architecture of the left atrium may be involved in ablation line reconnection 4 .…”

Section: Introductionmentioning

confidence: 99%

Histological Study of the Left Atrial Wall —A Consideration of the Compound Myocardial Architecture and Potential Durability with Respect to Catheter Ablation in Pulmonary Vein Isolation Procedures—

Ogawa

Inoue

Matsuyama

et al. 2010

Showa Univ J Med Sci

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“…In addition, Valles et al reported the importance of spontaneous PV triggers (accounting for 63% of all triggers) originating from the carina region in patients undergoing AF ablation. 34 Wongcharoen et al also found that 15% of AF patients had roof pouches and a longer roof line. 35 The location of the LA appendage and left PVs may affect catheter stability during the ablation, and an inferior LA appendage is more frequently observed in AF patients.…”

Section: Anatomical Identification and Integration Of Non-invasive Immentioning

confidence: 94%

Three-Dimensional Electroanatomic Mapping Systems in Catheter Ablation of Atrial Fibrillation

Chen

2010

Circ J

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Atrial fibrillation (AF) is the most common tachyarrhythmia, with a prevalence of 5% in people over the age of 65. Catheter ablation of AF has emerged as an important management choice for drug-refractory symptomatic paroxysmal or persistent AF. Three-dimensional (3D) electroanatomic mapping systems were introduced into catheter ablation of AF more than a decade ago. The 3D tool has the benefit of reducing the radiation exposure time, as well as voltage and fractionation mapping in order to identify the critical substrate during the ablation, prevent the formation of gaps, guide the ablation of post-ablation atrial tachycardia or flutter, and integrate images to improve the safety and long-term success rate. The 3D systems successfully enable safe and tailored radiofrequency ablation of AF in individual patients. (Circ J 2010; 74: 18 - 23)

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“…1,[6][7][8] In persistent AF, if triggers are specifically searched before ablation, most of them are also situated in the pulmonary veins. [9][10][11] Results from pharmacological and electrophysiological studies in animals and humans have yielded conflicting results regarding the mechanism of pulmonary vein firing.…”

Section: Trigger Ablation In Persistent Afmentioning

confidence: 99%

“…1,8,11 Once a trigger is identified, it has to be mapped and ablated. This can be very challenging, especially when multiple triggers are present.…”

Section: Trigger Ablation In Persistent Afmentioning

confidence: 99%

Catheter Ablation for Persistent Atrial Fibrillation

Roten

Derval

Jaı̈s

2012

Circ: Arrhythmia and Electrophysiology

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Localization of Atrial Fibrillation Triggers in Patients Undergoing Pulmonary Vein Isolation

Cited by 90 publications

References 25 publications

Histological Study of the Left Atrial Wall —A Consideration of the Compound Myocardial Architecture and Potential Durability with Respect to Catheter Ablation in Pulmonary Vein Isolation Procedures—

Histological Study of the Left Atrial Wall —A Consideration of the Compound Myocardial Architecture and Potential Durability with Respect to Catheter Ablation in Pulmonary Vein Isolation Procedures—

Three-Dimensional Electroanatomic Mapping Systems in Catheter Ablation of Atrial Fibrillation

Catheter Ablation for Persistent Atrial Fibrillation

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