Pulmonary Vein Isolation for Atrial Fibrillation in Patients With Paroxysmal Atrial Fibrillation and Prolonged Sinus Pause

Ohkubo, Kimie; Watanabe, Ichiro; Okumura, Yasuo; Ashino, Sonoko; Kofune, Masayoshi; Hashimoto, Kazuhito; Shindo, Atsushi; Sugimura, Hidezou; Nakai, Toshiko; Kasamaki, Yuji; Saito, Satoshi

doi:10.1536/ihj.48.247

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…[2][3][4] Though PVI has been established as a reliable therapy for curing AF, the recurrence rate has been relatively high and a repeat ablation procedure is sometimes required. [5][6][7][8] It has been reported that in some cases of unsuccessful ablation, antiarrhythmic drugs that were ineffective before the PVI may become effective (hybrid therapy) after. 5,9,10) However, the relationship between the BNP level and the effect of the hybrid therapy remains unknown.…”

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confidence: 99%

Plasma Brain Natriuretic Peptide Level After Hybrid Therapy With Pulmonary Vein Isolation and Antiarrhythmic Drugs for Atrial Fibrillation

et al. 2008

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SUMMARYThe atrial fibrillation (AF) recurrence rate after pulmonary vein isolation (PVI) has been relatively high and in some unsuccessful PVI cases, antiarrhythmic drugs that were ineffective before PVI may become effective (hybrid therapy). The purpose of this study was to investigate the relationship between the brain natriuretic peptide (BNP) level and the effect of the hybrid therapy.In 28 lone AF patients undergoing hybrid therapy, the plasma BNP level was measured before PVI and before and 3 months after administering an antiarrhythmic drug. Fifteen patients were free of AF after the hybrid therapy (effective group), and 13 still had recurrent AF after (noneffective group). At baseline, in all patients the BNP level was elevated, and there were no significant differences in the BNP level between the 2 groups. The BNP level was significantly decreased after PVI in the effective group (56.8 ± 23.1 versus 37.5 ± 16.7 pg/mL, P < 0.05) but not in the noneffective group (74.3 ± 47.8 versus 79.7 ± 54.4 pg/mL, NS). The elevated BNP level normalized in all effective group patients. The criterion consisting of a net value of < 60.0 pg/mL or a reduction in the BNP level of > 10.0 pg/mL after PVI predicted the effective group patients with a high accuracy.A significant reduction in the BNP level after PVI may be a useful predictor of the responders to antiarrhythmic drug therapy in patients with recurrent AF after PVI. The hybrid therapy may be effective in patients whose PVs serve as a dominant AF substrate. (Int Heart J 2008; 49: 143-151)

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Plasma Brain Natriuretic Peptide Level After Hybrid Therapy With Pulmonary Vein Isolation and Antiarrhythmic Drugs for Atrial Fibrillation

et al. 2008

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“…[1][2][3] Although previous studies of PV electrophysiology have proposed that triggered activity or reentry favored by left atrial inputs may cause PV tachycardia during AF, [4][5][6] the details of the mechanism of PV ectopic beats triggering AF are still unknown.…”

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Bigeminal Pulmonary Vein Ectopy Suppressed by Pulmonary Vein Isolation

et al. 2008

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SUMMARYA 58-year-old man with atrial fibrillation underwent pulmonary vein (PV) isolation (PVI). Bigeminal atrial premature beats persisted from the beginning of the PVI. The cardiac recordings from a basket catheter (BC) revealed the PV ectopic origin in the distal right superior PV. Successful PVI with the guidance of BC was confirmed by the appearance of concealed ectopy. Surprisingly, the PV ectopy completely disappeared immediately after the successful PVI. The findings suggest that the generation of PV trigger is sometimes dependent on left atrial input and that the underlying mechanism of the PV trigger may have been triggered activity or reentry. (Int Heart J 2008; 49: 129-132) Key words: Premature atrial contraction, Bigeminy, Pulmonary vein, Isolation THE pulmonary veins (PVs) have been demonstrated to be the major source of ectopic beats triggering paroxysmal atrial fibrillation (AF) and the electrical activity generating the ectopic beats can be recorded from the PV sleeve. 1-3)Although previous studies of PV electrophysiology have proposed that triggered activity or reentry favored by left atrial inputs may cause PV tachycardia during AF, 4-6) the details of the mechanism of PV ectopic beats triggering AF are still unknown. CASE REPORTA 58-year-old Japanese man with idiopathic, drug-refractory paroxysmal AF was referred for an electrophysiologic study (EPS) and radiofrequency catheter ablation. He complained of palpitations from AF which continued for a few hours, 2 or 3 times a week despite taking antiarrhythmic drugs. There was no echocardiographic evidence of structural heart disease. The left atrial dimension From the

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“…However, it has also been shown that the electro-anatomic changes in the sinus node are reversible after control of AF, 3) and successful catheter ablation of AF resolves the clinical manifestation of sinus node dysfunction in TBS patients. 13) 14) 15) This has led to the emergence of catheter ablation of AF as an important treatment option for patients with TBS.…”

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confidence: 99%

Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome

et al. 2020

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Background and Objectives Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardia-bradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse. Methods The medical records of 217 patients with TBS were retrospectively assessed. Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death. Results During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27; 95% confidence interval [CI], 0.15–0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06–0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71–6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8–2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50–1.66; p=0.769). Conclusions RFCA is an effective alternative to PM implantation in patients with TBS. In these patients, successful RF ablation of AF is related to a higher rate of sinus rhythm maintenance compared to PM implantation, and the composite outcome of cardiovascular rehospitalization and death is similar.

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Pulmonary Vein Isolation for Atrial Fibrillation in Patients With Paroxysmal Atrial Fibrillation and Prolonged Sinus Pause

Abstract: SUMMARYBackground: Symptomatic prolonged sinus pauses upon termination of atrial fibrilla-

Cited by 8 publications

References 18 publications

Plasma Brain Natriuretic Peptide Level After Hybrid Therapy With Pulmonary Vein Isolation and Antiarrhythmic Drugs for Atrial Fibrillation

Plasma Brain Natriuretic Peptide Level After Hybrid Therapy With Pulmonary Vein Isolation and Antiarrhythmic Drugs for Atrial Fibrillation

Bigeminal Pulmonary Vein Ectopy Suppressed by Pulmonary Vein Isolation

Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome

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