Marshall Vein as Arrhythmogenic Source in Patients with Atrial Fibrillation: Correlation Between its Anatomy and Electrophysiological Findings

Kurotobi, Toshiya; Ito, Hiroshi; Inoue, Koichi; Iwakura, Katsuomi; Kawano, Shigeo; Okamura, Atsunori; Date, Motoo; Fujii, Kenshi

doi:10.1111/j.1540-8167.2006.00542.x

Cited by 75 publications

(71 citation statements)

References 32 publications

(61 reference statements)

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“…[22][23][24][25][26][27][28][29][30] However, in the present series, exclusion of the LA posterior wall had no effect on the incidence of AF recurrences after CPVA. It should be noted that a larger area of posterior venous-atrial tissue was excluded when PV encirclement was performed in this study as compared with procedures in which PVs are ablated at their ostia.…”

Section: Discussioncontrasting

confidence: 48%

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

Tamborero

Mont

Berruezo

et al. 2009

Circ: Arrhythmia and Electrophysiology

140

115

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Background-Ablation of the pulmonary veins (PVs) for atrial fibrillation treatment is often combined with linear radiofrequency lesions along the left atrium (LA) to improve the success rate. The study was designed to assess the contribution of LA posterior wall isolation to the outcome of circumferential pulmonary vein ablation (CPVA). Methods and Results-CPVA consisted of continuous radiofrequency lesions encircling both ipsilateral PVs plus an ablation line along the mitral isthmus. Patients were then randomized into 2 groups. In the first group, superior PVs were connected by linear lesions along the LA roof (CPVA-1 group). In the second group, the LA posterior wall was isolated by adding a second line connecting the inferior aspect of the 2 inferior PVs (CPVA-2 group). The study included 120 patients (53Ϯ11 years, 77% male, 60% paroxysmal atrial fibrillation, LA of 41.3Ϯ5.4 mm, 46% with hypertension, and 22% with structural heart disease). After a single ablation procedure and a mean follow-up of 10Ϯ4 months, 24 (40%) patients of the CPVA-1 group had atrial fibrillation recurrences and 3 (5%) had new-onset LA flutter. In the CPVA-2 group, recurrences were due to atrial fibrillation episodes in 23 patients (38%) and LA flutter in 4 (7%). Freedom from arrhythmia recurrences was not statistically different in the CPVA-1 group as compared with the CPVA-2 group (log rank Pϭ0.943). Conclusion-Isolation

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Section: Discussioncontrasting

confidence: 48%

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

Tamborero

Mont

Berruezo

et al. 2009

Circ: Arrhythmia and Electrophysiology

140

115

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“…3,25 The relationship between the precise ISP dose and arrhythmogenic inducibility remains unknown; however, the majority of PV/non-PV foci may be revealed during a high dose isoproterenol administration of up to 20 g/min or after cardioversion of AF. 2,26 High-dose ISP often invokes vagally mediated nerve reflex bradycardia, which appears to cause an increased arrhythmogenicity due to autonomic nerve competition.…”

Section: Induction Of Arrhythmogenic Focimentioning

confidence: 99%

Multiple Arrhythmogenic Foci Associated With the Development of Perpetuation of Atrial Fibrillation

Kurotobi

Iwakura

Inoue

et al. 2010

Circ: Arrhythmia and Electrophysiology

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Background-The presence of multiple arrhythmogenic sources may be associated with the perpetuation of atrial fibrillation (AF). In this study, we investigated the hypothesis that multiple foci might be involved in the development of AF persistency. Methods and Results-Two hundred fourteen consecutive patients with AF undergoing catheter ablation were enrolled in this study. The location of the arrhythmogenic foci was determined using simultaneous recordings from multipolar catheters before and after pulmonary vein isolation during an isoproterenol administration. We detected 500 arrhythmogenic foci (263 foci as AF initiators, and 237 foci as non-AF initiators). High-dose isoproterenol infusions (ranging from 2 to 20 g/min) revealed potential arrhythmogenic foci, especially non-pulmonary vein foci (55%). Persistent AF was more highly associated with an incidence of multiple (Ͼ2) foci than paroxysmal AF (88% versus 65%, Pϭ0.002), and a multivariate analysis demonstrated that multiple foci (Ͼ2) were an independent contributing factor for persistent AF (odds ratio; 95% confidence interval, 4.69; 1.82 to 12.09, PϽ0.001). In paroxysmal AF, the number of foci was higher in patients with long-term AF (Ͼ24 hours) than in those with short-lasting AF (2.64Ϯ0.14 versus 1.77Ϯ0.16, Pϭ0.001). In the persistent AF group, the patients with short-lasting AF (Ͻ12 months) had a greater number of foci than did those with long-term AF (Ͼ12 months) (3.62Ϯ0.15 versus 1.92Ϯ0.16, Pϭ0.04). Conclusions-Multiple foci were likely to be involved in the development of persistent AF. However, if AF persisted for Ͼ12 months, they may not have had a significant effect on the AF perpetuation. (Circ Arrhythm Electrophysiol. 2010; 3:39-45.)

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“…However, neither of the studies considered PV isolation as a procedural endpoint for CPVA, namely CPVI which many studies have shown results in higher efficacy for CPVI in the treatment of AF. [11][12][13][14][15] Moreover, both those studies used conventional SPVI to isolate the PVs. Compared with them, 3,5 the present study has 2 different features: (1) PV isolation, rather than voltage abatement, was the primary endpoint of CPVI and (2) after systemic SPVI, we performed additional LA linear ablation for patients with sustained or inducible AF.…”

Section: Previous Studiesmentioning

confidence: 99%

“…[11][12][13] CPVI approach is designed to produce 2 circular lesion sets along the PV antrum, with the endpoint of PV isolation. As demonstrated by Ouyang et al, 9 CPVI alone (without additional LA linear lesions) is very effective in treating PAF, but the approach also has some demerits because of the nature of a predetermined anatomic lesion set.…”

Section: Ablation Approachesmentioning

confidence: 99%

“…Ablation was performed using a 4-mm, irrigated-tip catheter (Celsius Thermcool™, Biosense-Webster, USA) with CPVI The technique of CPVI has been described previously in detail. 9,11 Briefly, after the PVs were outlined via angiography, the 3-dimensional (D) LA geometry was created using an electroanatomical mapping system (CARTO XP, Biosense-Webster, USA) with a 3.5 mm irrigated tip ablation catheter (Navi-Star, Thermocool™, Biosense-Webster, USA). The ipsilateral PV antrum was then carefully mapped using a combination of venography, electrogram evaluation and the drop-off site of the mapping catheter while dragging it out of the vein.…”

Section: Ablation Protocolmentioning

confidence: 99%

See 1 more Smart Citation

Is Circumferential Pulmonary Vein Isolation Preferable to Stepwise Segmental Pulmonary Vein Isolation for Patients With Paroxysmal Atrial Fibrillation? A Randomized Study

Liu

Dong

et al. 2006

Circ J

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uring the past decade, a variety of transcatheter ablation strategies targeting the pulmonary veins (PVs) have emerged for the treatment of patients with symptomatic atrial fibrillation (AF). Among them, segmental PV isolation (SPVI) and circumferential PV ablation (CPVA) are 2 approaches gaining more popularity. 1,2 Several studies have compared the efficacy of these 2 most widely used approaches; however, the conclusions are controversial. [3][4][5] Recently, 2 new ablation approaches based on the traditional SPVI and CPVA have evolved to treat patients with AF. Haissaguerre's laboratory introduced a stepwise SPVI approach, which is characterized by stepwise left atrial (LA) linear ablation tailored by inducibilty of AF after systemic SPVI. [6][7][8] Meanwhile, CPVA with the endpoint of PV isolation, so-called circumferential PV isolation (CPVI), has also been developed by another pioneer laboratory. 9 Both of these approaches share high efficacy in treating patients with AF in the literature; however, their relative merits and demerits have not been elucidated.At present, patients with paroxysmal AF (PAF), particularly those refractory to anti-arrhythmic drugs (AADs), are considered as the ideal candidates for catheter ablation therapy. 10 However, the preferred approach for this subset of patients with AF has not been established. Thus, the aim

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Marshall Vein as Arrhythmogenic Source in Patients with Atrial Fibrillation: Correlation Between its Anatomy and Electrophysiological Findings

Abstract: To determine VOM anatomy is important to identify non-PV foci around the ends of VOM.

Cited by 75 publications

References 32 publications

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation

Multiple Arrhythmogenic Foci Associated With the Development of Perpetuation of Atrial Fibrillation

Is Circumferential Pulmonary Vein Isolation Preferable to Stepwise Segmental Pulmonary Vein Isolation for Patients With Paroxysmal Atrial Fibrillation? A Randomized Study

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