The Efficacy of Inducibility and Circumferential Ablation with Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation

Abstract

After a single procedure of circumferential ablation with PVI and noninducibility, 82% patients did not have recurrence of AF. The inducibility of AF was related to the recurrence of AF. The atrial substrate affected the outcome of the inducibility.

Long-Term Benefits Following Catheter Ablation of Atrial Fibrillation

“…3 Other potential immediate procedural goals may include successful isolation of sites of non-pulmonary vein triggers such as the superior vena cava or coronary sinus; elimination of sites harboring complex fractionated atrial electrograms (CFAE); 4 linear ablation with bidirectional block; 5 ablation of sites harboring ganglionated plexi; 6,7 ablation utilizing electrogram analysis to eliminate sites of AF rotors or other drivers; 8-10 ablation with a goal of conversion to SR during ablation; 11 or ablation until the absence of any atrial arrhythmias during attempts at reinduction. 12 Following PVI, data supporting the use of any particular strategy over another for improved longterm clinical outcomes is inconsistent and adjunctive strategies to PVI are often selected based on operator experience he earliest reports of catheter ablation of atrial fibrillation (AF) in humans date to the early and mid 1990 s 1,2 when ablation to produce linear lesions was performed to emulate portions of the surgical maze procedure. Recognition and targeting of pulmonary vein (PV) drivers in the late 1990 s led to a dramatic rise in the efficacy and prominence of catheter ablation, particularly for paroxysmal AF.…”

Associations Between Renal Function, Atrial Substrate Properties and Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation

“…The details have been described previously. [15][16][17][18] In brief, after completing the RA and LA geometry, a sequential contact voltage map was constructed in all patients during sinus rhythm. For the patients with an AF occurrence during the procedure, external direct current cardioversion was performed to convert the patients to sinus rhythm before mapping was performed.…”

“…The requirement of additional ablation was assessed based on the AF inducibility. 17 After completing the PV isolation, the ablation was only applied to spontaneously initiating focal atrial tachycardias and non-PV ectopy that initiated AF. The methods of the identification of the non-PV ectopy have been described in our previous publications.…”

The Impact of Diastolic Dysfunction on the Atrial Substrate Properties and Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation

“…10 The pulmonary vein (PV) ostia were identified by fluoroscopy and marked on the 3-D map of the left atrium. Continuous circumferential lesions were created encircling the right and left PV ostia guided by the NavX system using a 4-mm tip ablation catheter (EP Technologies/Boston Scientific Corporation, Natick, MA, USA) or internal irrigated-tip catheter (EP Technologies/ Boston Scientific Corporation).…”