电解剖系统引导下环肺静脉线性消融隔离肺静脉治疗心房颤动

目的采用双Lasso导管标测技术行环肺静脉及其周围组织隔离预防心房颤动复发。方法13例心房颤动(房颤)患者,男性8例,女性5例,平均年龄为(56±8)岁,行电生理检查和射频导管消融。其中,8例为频发的阵发性房颤(1~20年),5例为持续性房颤(1~4年)。窦性心律下起搏远端冠状静脉窦或房颤发生时,利用电解剖系统进行左心房重建。然后,将两根Lasso多极导管同时置于右(左)上、下肺静脉之内。在距肺静脉口1cm左右处行环肺静脉及其周围组织电隔离。消融终点为左心房-肺静脉/周围组织完全性阻滞,表现为放电时肺静脉电位消失。结果7例阵发性房颤患者在窦性心律下电隔离成功,5例持续性房颤和1例阵发性房颤患者在窦性心律和房颤发生时电隔离成功。3例患者放电时房颤终止:左肺静脉隔离时房颤终止1例,右肺静脉隔离时房颤终止1例,左肺静脉隔离完成后54s自行终止1例。其余3例需体外电转复。消融术时间为(256±56)min,X线曝光时间为(39±11)min。无并发症发生。在术后平均随访(104±50)d,只有1例患者在第71d时出现不典型心房扑动,自行终止。其余12例患者均无房性快速性心律失常复发。结论有明确心电学隔离指标的环肺静脉及其周围组织电隔离是一种安全有效的方法。肺静脉既可为房颤的诱发机制,亦有可能参与房颤的维持机制。     

Electrophysiologically guided pulmonary vein isolation during sustained atrial fibrillation

INTRODUCTION: Sustained atrial fibrillation (AF) is frequently encountered during pulmonary vein (PV) isolation. The aim of this study was to evaluate the feasibility and safety of PV isolation during sustained AF. METHODS AND RESULTS: Thirty-seven patients (30 men, age 54 +/- 10 years) underwent Lasso-guided isolation of 87 PVs during sustained AF. Baseline PV electrogram patterns were classified into one of two types: organized, with consistent PV activation sequence; or disorganized, with constant variation of PV activation sequence. In disorganized activity, radiofrequency ablation was performed circumferentially around the Lasso while the earliest PV potential was targeted during organized activity. Complete left atrial (LA) to PV block during AF was identified by abolition or dissociation of all sharp potentials recorded within the vein. PV isolation then was verified during sinus rhythm. Baseline activation patterns of PV potential were organized in 32 PVs (37%) [more frequently in inferior veins than superior veins (53% vs 26%, P = 0.01)] and disorganized in 55 PVs (63%). In 59 of 87 PVs, isolation was begun and completed during AF. Radiofrequency ablation organized PV activation sequence in 75% prior to isolation. LA-PV block was confirmed during sinus rhythm in 54 (92%) of 59 PVs. In 28 of 87 PVs, sinus rhythm was restored before complete LA-PV block. Complete isolation was achieved in all 87 PVs without complications. CONCLUSION: PV isolation can be effectively and safely performed during sustained AF, preceded in most cases by organization of PV electrogram activity. This strategy may be the preferred alternative to multiple intraprocedural cardioversions.     

Paroxysmal cycle length shortening in the pulmonary veins during atrial fibrillation correlates with arrhythmogenic triggering foci in sinus rhythm

INTRODUCTION: The focal origin of atrial fibrillation (AF) is identified by recording atrial ectopic beats or the ectopic activity that precedes AF. We hypothesized that arrhythmogenic pulmonary veins (PVs) also could be identified during persistent AF. METHODS AND RESULTS: Patients with persistent AF referred for focal ablation were enrolled prospectively. During AF, bipolar electrograms were recorded from each PV for a minimum of 120 seconds, as well as from the right atrium and coronary sinus. The cycle length of activity in each PV was measured during AF and plotted on a frequency histogram. Following cardioversion to sinus rhythm, arrhythmogenic PVs were identified from reinitiation of AF or from ectopic beats. Ten patients were enrolled and 37 PVs analyzed. During AF, 17 PVs demonstrated bimodal cycle length frequency histograms, with periods of paroxysmal short cycle length recording. Following cardioversion, 14 PVs were identified as arrhythmogenic as defined earlier. Each of these arrhythmogenic PVs showed paroxysmal short cycle length recording during AF. Sensitivity was 87%, specificity 91%, positive predictive value 87%, and negative predictive value 100%. CONCLUSION: The arrhythmogenic PVs responsible for the focal activity that triggers AF also demonstrate paroxysmal short cycle length recording during sustained AF. These results demonstrate that arrhythmogenic PVs still can be identified reliably, even during sustained AF.     

环肺静脉口部线性消融治疗心房颤动的初期体会

目的报告环肺静脉口部线性消融治疗心房颤动(房颤)的初期体会和结果。方法56例药物治疗无效的房颤患者(阵发性房颤50例,持续性房颤6例)入选,平均年龄(50.6±9.6)岁。利用三维电解剖标测系统,围绕左和右侧肺静脉口部线性消融左心房,另外二条消融线分别连接左、右环状消融线以及左环状消融线至二尖瓣环。术后服用抗心律失常药3个月。结果55例患者接受消融治疗,其中53例完成预定的线性消融,操作时间和X线曝光时间分别为(193±56)min和(35±11)min。术中14例患者为房颤心律,其中8例(57.1%)消融过程中恢复窦性心律;20例出现迷走神经反射现象。随访时间>3个月(7.3±3.4)个月的41例,其中无房颤发作者25例(包括2例仍服用胺碘酮,61.0%),房颤发作次数和持续时间明显减少者11例(26.8%),无效者5例。无1例发生肺静脉狭窄。结论纯解剖方式的环肺静脉口部线性消融治疗房颤是安全可行的。其主要治疗机制是改变房颤的心房基质和去迷走神经作用。     

Clinical predictors of noninducibility of sustained atrial fibrillation after pulmonary vein isolation

BACKGROUND: Noninducibility of sustained atrial fibrillation (AF) after pulmonary vein isolation (PVI) has been shown to be associated with a better clinical outcome. We evaluated the role of clinical variables that could predict noninducibility of sustained AF after PVI. METHODS AND RESULTS: Data were collected prospectively from 181 patients (153 male; age 54 +/- 9 years) referred for ablation of drug-refractory symptomatic paroxysmal AF (duration < or =7 days). Clinical variables were evaluated with regard to their ability of predicting noninducibility of sustained AF (< or =10 minutes) after PVI. Univariate analysis was performed on all collected variables followed by multivariate analysis for variables showing a P value <0.1. After PVI, sustained AF was noninducible in 97 (54%) patients. The following clinical variables showed a significant difference between the groups: body weight, longest AF episode, duration of AF history, presence or absence of structural heart disease, left ventricular (LV) hypertrophy, prior cardioversion, left atrial (LA) parasternal, and longitudinal diameters and LV diameters. On multivariate analysis, three independent predictors of noninducibility were identified: a shorter duration of AF episodes (AF <12 hours: RR 0.01 (0.002-0.06), P < 0.001; AF 12-48 hours: RR 0.07 (0.01-0.37), P = 0.001); LA longitudinal diameter <57 mm (RR 0.33 (0.13-0.82), P = 0.016); and absence of LV hypertrophy (RR 0.15 (0.04-0.63), P = 0.01). CONCLUSIONS: Shorter AF episodes, smaller LA longitudinal diameter, and absence of LV hypertrophy are independent predictors of noninducibility of sustained AF after PVI.     

三维标测与肺静脉环状标测联合应用于心房颤动导管消融术

目的　探讨左心房三维电解剖标测与肺静脉环状标测联合指导下行心房颤动 (房颤 )导管消融术治疗房颤的可行性。方法　连续 14例药物治疗无效的房颤患者 ,男 10例 ,女 4例 ,平均年龄 5 2 4± 12 8(2 8～ 74 )岁 ,平均左心房内径 4 6 7± 5 4mm。其中阵发性房颤 10例、永久性房颤 3例、持续性房颤 1例。首先在三维标测系统指导下行左心房基质改良术 ,然后在肺静脉环状标测指导下行肺静脉节段性消融术。消融终点包括以下三点 :(1)完成所有预设的左心房消融径线 ;(2 )全部肺静脉均达电隔离 ;(3)阴性诱发结果。结果　 (1) 10例 (71 4 % )阵发性房颤达到消融终点 ;(2 )手术的总操作时间和X线曝光时间分别为 2 92± 4 9min和 5 4± 9min ;(3)随访 5 2± 5 7(1～ 2 3)周 ,7例 (5 0 % )阵发性房颤患者可以无需抗心律失常药物而维持窦性心律 ,3例 (2 1 4 % )阵发性房颤发作显著减少 ,4例 (2 8 6 % )持续性 永久性房颤仍为房颤 ;(4 )术中及随访期无任何操作相关并发症。结论　左心房三维标测与肺静脉环状标测联合应用于房颤的导管消融术安全可行 ,对于左心房增大的阵发性房颤患者具有一定效果     

阵发性心房颤动的三维电解剖标测指导左心房线性消融治疗

目的探讨三维电解剖标测指导左心房线性消融治疗阵发性心房颤动(房颤)的有效性和安全性。方法对29例入选的阵发性房颤患者使用Carto系统建立左心房三维电解剖图,结合肺静脉造影确定肺静脉开口,围绕左、右上、下肺静脉口完成环肺静脉线性消融。预设温度43℃,最大功率30W,每点消融时间大于20s。局部电位振幅降低50%以上再移动靶点,逐点完成预定消融线。结果本组患者平均操作时间180±18min,透视时间80±20min。平均放电次数120±15次。术后随访6个月。24例无房颤再发;3例在术后3个月内再发房颤,但次数较前明显减少,6个月后无房颤再发;1例偶有房颤发作;1例复发。所有患者均无肺静脉狭窄发生。结论三维电解剖标测指导左心房线性消融治疗阵发性房颤,在成功率及安全性上具有明显的优势。     

联合应用磁共振扫描与三维电解剖标测系统图像融合技术及Lasso导管标测技术指导环肺静脉隔离治疗心房颤动

目的报道联合应用三维电解剖标测系统图像融合技术(Carto-Merge)及Lasso导管标测技术指导环肺静脉电隔离术治疗心房颤动(房颤)的结果。方法共入选56例症状明显、药物治疗无效的阵发性房颤患者,男性41例,女性15例,平均年龄58·5±12·7岁。应用Carto-Merge技术定位肺静脉口,之后环双侧肺静脉前庭线形消融左心房,终点为Lasso导管所标测的同侧肺静脉电位消失或肺静脉电位与心房电活动的分离。结果全组患者的电解剖标测点与影像图像(MRI)的空间差距均值1·79±0·33mm。首次手术的肺静脉隔离率为92·9%(52/56)。经随访18·3±5·7个月,有73·2%的患者(41/56)仍维持窦性心律。10例患者接受再次消融;经再次随访8·2±6·9个月,8位患者仍维持窦性心律。无一例患者出现肺静脉狭窄。结论联合应用Carto-Merge及Lasso导管标测技术,可有效地确保肺静脉的隔离,降低肺静脉狭窄等并发症的发生率。     

三维标测系统指导下环肺静脉消融治疗心房颤动

目的 探讨三维标测系统指导下环肺静脉消融治疗心房颤动的安全性和有效性.方法 阵发性心房颤动92例和持续性或永久性心房颤动36例,接受环肺静脉消融术.采用Carto电解剖标测系统,进行环肺静脉左心房线性消融,消融终点为肺静脉电隔离.手术结束时对心律仍为心房颤动者行同步直流电心脏复律.结果 完成"解剖学"环形消融线256条,其中58.6%达到电隔离肺静脉的终点,经寻找缝隙补充消融后最终248条(96.9%)消融线达到终点.手术时间(231±45)min、X线曝光时间(42±13)min和放电时间(66±17)min.术后随访平均10个月,无复发101例(78.9%).接受了再次手术15例,心内电生理检查证实14例有左心房-肺静脉传导,射频消融成功并随访30～270 d,两次射频消融术后总成功率为87.5%,其中阵发性心房颤动成功率为93.0%,持续性或永久性心房颤动为76.7%.并发症发生率为6.2%,包括心包填塞2例、小脑梗死2例、股静脉穿刺部位血肿1例和左侧大量血胸1例,经治疗后均痊愈.结论 以肺静脉电隔离为目标的环肺静脉消融术治疗心房颤动有效和安全.     

A single pulmonary vein as electrophysiological substrate of paroxysmal atrial fibrillation

Introduction: It has been demonstrated that pulmonary veins (PVs) play an important role in initiation and maintenance of paroxysmal atrial fibrillation (AF). However, it is not clearly known whether a single PV acts as electrophysiological substrate for paroxysmal AF.
Methods and Results: This study included five patients with paroxysmal AF. All patients underwent complete PV isolation with continuous circular lesions (CCLs) around the ipsilateral PVs guided by a three-dimensional mapping system. Irrigated radiofrequency (RF) delivery was performed during AF on the right-sided CCLs in two patients and on the left-sided CCLs in three patients. The incomplete CCLs resulted in a change from AF to atrial tachycardia (AT), which presented with an identical atrial activation sequence and P wave morphology. Complete CCLs resulted in AF termination with persistent PV tachyarrhythmias within the isolated PV in all five patients. PV tachyarrhythmia within the isolated PV was PV fibrillation from the left common PV (LCPV) in two patients, PV tachycardia from the right superior PV (RSPV) in two patients, and from the left superior PV in one patient. All sustained PV tachyarrhythmias persisted for more than 30 minutes, needed external cardioversion for termination in four patients and a focal ablation in one patient. After the initial procedure, an AT from the RSPV occurred in a patient with PV fibrillation within the LCPV, and was successfully ablated.
Conclusion: In patients with paroxysmal AF, sustained PV tachyarrhythmias from a single PV can perpetuate AF. Complete isolation of all PV may provide good clinical outcome during long-term follow-up.     

Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation

Pulsed‐field ablation (PFA) is a promising new ablation modality for the treatment of atrial fibrillation. This energy form employs a train of microsecond duration high amplitude electrical pulses that ablate myocardium by electroporation of the sarcolemmal membrane without measurable tissue heating. The ablation pulse waveform has multiple variable components that can affect ablation efficacy, thus each proprietary system has unique properties that cannot be generalized to other systems. Success with PFA depends upon the proximity of the electrode to the target tissue, but not necessarily upon contact. A unique feature of PFA is tissue specificity. Myocardium is very susceptible to irreversible injury whereas the esophagus, phrenic nerves, pulmonary veins, and coronary arteries are relatively resistant to injury. The tissue specificity of PFA may result in a wide therapeutic range and improved safety profile during atrial fibrillation ablation. Vein isolation can be achieved very rapidly (seconds) promising that PFA may reduce procedure time to 1 hour or less. This attractive new technology promises to be a major advance in the field of atrial fibrillation ablation.     

应用重叠参考图像透视技术易化环肺静脉电隔离术操作治疗阵发性心房颤动

目的 探讨重叠参考图像透视技术(Overlay Ref)对环肺静脉电隔离术治疗阵发性心房颤动(房颤)的影响.方法 入选194例阵发性房颤患者,随机分为Overlay Ref组(97例)及对照组(97例).Overlay Ref组使用Overlay Ref技术(将参考图像以反白的形式叠加于透视屏上)辅助环肺静脉电隔离术的操作.对照组常规方法完成环肺静脉电隔离术.比较两组的总消融手术时间、消融时间、X线曝光量、肺静脉隔离率及随访1年的成功率.结果 两组患者的基线临床特征差异无统计学意义.所有患者均接受了环肺静脉电隔离术.Overlay Ref组的消融时间〔(89±13) min对(102±22) min,P＜0.01〕和总消融术时间[ (139±22) min对(162±31) min,P＜0.01]均明显比对照组短.Oveday Ref组的X线曝光量[( 13531±283) mGy对(13123±369)mGy]稍大,但差异无统计学意义(P＞0.05).两组的环肺静脉电隔离率(97.9％对96.9％,P=NS)及随访1年的成功率(84.5％对81.4％,P＞0.05)差异也无统计学意义.结论 Overlay Ref技术可以易化环肺静脉电隔离术的操作,缩短房颤导管消融术的学习曲线.     

Efficacy of repeat pulmonary vein isolation procedures in patients with recurrent atrial fibrillation

INTRODUCTION: Pulmonary vein (PV) isolation is effective in the treatment of most patients with atrial fibrillation (AF). Some advocate the addition of linear ablation techniques to improve efficacy; however, previous studies suggest recurrent PV conduction is responsible for AF recurrence. The aim of this study was to determine the effectiveness of repeat PV isolation in patients with recurrent AF after an initial ablation procedure and to determine if any patient characteristics predict failure of repeat PV isolation procedures. METHODS AND RESULTS: Seventy-four patients with two or more AF ablation procedures using selective PV isolation were included. PV isolation was guided with multielectrode ring catheter recordings, electroanatomic mapping, and intracardiac electrocardiography. Radiofrequency energy was delivered using a 4-mm-tip catheter (maximum 40 W, 52 degrees C); cooled-tip ablation was performed in 10 patients. Linear ablation was not performed. Antiarrhythmic drugs were continued for at least 6 weeks after ablation; AF episodes during this period were censored. Reconnection of one or more segments of previously ablated PVs was observed in 97% of patients; reconnected PVs served as the trigger for AF in 77%. Repeat PV isolation resulted in AF control (cure or 90% reduction in AF episodes) in 64 patients (86%) over a follow-up period of 9.1 +/- 6.7 months. "High-risk" characteristics such as left atrial enlargement, persistent AF, or mitral regurgitation did not predict failure of repeat PV isolation procedures. CONCLUSION: Recurrent AF following selective PV isolation is overwhelmingly associated with PV electrical reconnection. Repeat PV isolation without linear ablation provides effective treatment for recurrent AF in patients in whom an initial PV isolation procedure failed, independent of clinical characteristics.     

三维电解剖标测及单根环状标测电极指导下CPVA术治疗心房颤动

目的探讨在三维电解剖标测及单根环状标测电极指导下以环肺静脉口电隔离术（CPVA）为核心治疗心房颤动（房颤）的疗效。方法对32例房颤患者均在CARTO三维电解剖标测及单根环状标测电极指导下行CPVA,其中辅助行碎裂电位消融6例,上腔静脉消融术2例,三尖瓣峡部、二尖瓣峡部及冠状窦内消融各1例。结果26例阵发性房颤不再被诱发,6例慢性房颤中术中房颤终止2例、电复律转为窦性心律4例;手术操作时间（119&#177;37）min,X线透视时间（25&#177;12）min;随访（9&#177;5）个月成功率为90.6%。均无手术并发症。结论三维电解剖标测及单根环状标测电极指导下以CPVA为核心,其他消融方法为辅的房颤消融策略安全有效,可提高消融成功率,缩短手术时间,减少并发症、复发。     

CARTO系统指导下环肺静脉前庭电学隔离治疗心房颤动的初步探讨

目的总结三维标测系统（CARTO）指导下环肺静脉前庭电学隔离治疗心房颤动的临床意义。方法12例患者（其中阵发性房颤8例，持续性房颤4例）接收手术，阵发房颤采用Pappone术式，持续性房颤采用联合Pappone及Nademanee术式。术后随访5—18个月。结果所有患者均成功达到消融终点，1例患者复发房颤。结论三维标测系统指导下采用Pappone及Nademanee术式治疗房颤是安全可靠的。     

Pulmonary vein isolation using segmental versus electroanatomical circumferential ablation for paroxysmal atrial fibrillation

PURPOSE: We tested the hypothesis that electroanatomic pulmonary vein (PV) antra encircling for the PV isolation will improve the outcome in treatment of paroxysmal atrial fibrillation (PAF), compared with segmental PV isolation. METHODS: Fifty-four patients underwent segmental PV isolation (group 1) and 56 patients circumferential PV isolation (group 2) for symptomatic PAF in a randomized study. RESULTS: Following single ablation procedure, at the 48 +/- 8 month follow-up, 30 (56%) and 32 (57%) patients in groups 1 and 2 remained free of arrhythmia (P = 0.41). After repeat ablation, 43 (80%) and 45 (80%) patients in groups 1 and 2 were free of arrhythmia without antiarrhythmic drugs (AADs); 48 (89%) and 51 (91%) patients in groups 1 and 2 did not have arrhythmia recurrences without or with AADs. CONCLUSION: This study demonstrates no advantage in long-term arrhythmia-free clinical outcome after circumferential PV isolation in patients with frequent PAF.     

Factors associated with early atrial fibrillation after ablation of common atrial flutter. A single centre prospective study.

BACKGROUND: The occurrence of early atrial fibrillation (< or = 6 months) after ablation of common atrial flutter is of clinical significance. Variables predicting this evolution in ablated patients without a previous atrial fibrillation history have not been fully investigated. OBJECTIVES: The aim of the present study was: (1) to identify predictive factors of early atrial fibrillation (< or = 6 months) in the overall population following atrial flutter catheter ablation; (2) to identify predictive variables of early atrial fibrillation following (< or = 6 months) atrial flutter catheter ablation within a subgroup of patients without documented prior atrial fibrillation. METHODS: This study prospectively included 96 consecutive patients (age 65 +/- 13 years; 18 women) over a 12-month period. Their counterclockwise flutter was ablated by radiofrequency, by the same operator, with an 8-mm-tip catheter. Clinical, electrophysiological and echocardiographic data were collected and 27 variables were retained for analysis: age; gender; type of atrial flutter (permanent vs paroxysmal); symptom duration (months +/- SD); pre-ablation history of atrial fibrillation; structural heart disease; left ventricular ejection fraction (%); left atrial size (mm); cava--tricuspid isthmus dimension; septal isthmus dimension; systolic pulmonary pressure > or < or = 30 mmHg; right atrial area; left atrial area; isthmus block; number of radiofrequency applications (+/- SD); antiarrhythmic drugs at discharge; left ventricular diastolic diameter; left ventricular systolic diameter; left ventricular telediastolic volume; left ventricular telesystolic volume; A-wave velocity (cm . s(-1)); E-wave velocity (cm . s(-1)); E/A; isovolumetric relaxation time; E-wave deceleration time; significant mitral regurgitation and flutter cycle length (ms). RESULTS: Of the 96 consecutive ablated patients, early atrial fibrillation was documented in 16 patients (17%). Atrial fibrillation occurred 30 +/- 46 days (range 1 to 171 days) after ablation. Univariate analysis associated an early occurrence of atrial fibrillation with: atrial fibrillation history, left ventricular ejection fraction, left atrial size, left ventricular telesystolic volume, A-wave velocity, significant mitral regurgitation and flutter cycle length. Multivariate analysis using a Cox model found that the only independent predictors of early atrial fibrillation were left ventricular ejection fraction and pre-ablation history of atrial fibrillation. In the subgroup without prior atrial fibrillation history (n=63; 66%), the only independent predictor of early atrial fibrillation was the presence of a significant mitral regurgitation. CONCLUSIONS: In a subgroup of patients without atrial fibrillation history, 8% of patients revealed an early atrial fibrillation. Mitral regurgitation is a strong predictive factor of early atrial fibrillation occurrence with 80% sensitivity, 78% specificity and 98% negative predictive value. These data should be considered in post-ablation management.     

射频消融治疗局灶性心房颤动初步结果

目的　评价射频消融治疗由房性早搏 (房早 )诱发的局灶性心房颤动 (房颤 )的安全性和可靠性 ,并探讨有关射频消融治疗中一些方法学问题。　方法　 1例 44岁女性患者 ,阵发房颤 4年余 ,心电图证实房颤由房早诱发 ,药物治疗无效 ,行射频消融治疗。放置常规电生理检查导管和 Halo导管 ,穿刺房间隔 ,大头导管经房间隔在左房内肺静脉进行标测 ,在左上肺静脉内标测到诱发房颤的房早时最早心房激动 ,放电消融 3次 ,房早、房颤消失。结果　随访两周后有房早和短阵房颤发生 3次 ,术后两周至 6个月未服用药物 ,无房颤发生。结论　射频消融可能成为治疗局灶性房颤一种安全有效的方法。     

A three-pulmonary vein isolation approach to treat paroxysmal atrial fibrillation

To investigate the safety and efficacy of a 3-pulmonary vein (PV) isolation approach in treatingparoxysmal atrial fibrillation (AF).Methods Radiofrequency catheter ablation was used to eliminate PVpotential in 11 patients with frequent paroxysmal AF refractory to anti-arrhythmic agents.During sinus rhythm,PVpotential was mapped in the left and right superior PVs and left inferior PV.The procedural success was defined asthe elimination of PV potential in the 3 PVs.Results PV potential was identified and abolished in a total of 24PVs,mostly in the left and fight superior PV.There was no pulmonary stenosis or other complications during or afterthe procedures.AF recurred in one patient after an average of 12±3 month follow-up.Conclusions PVpotentials were present mostly in the left or right superior PV.The 3-PVs isolation approach is safe and effective inpreventing drug-resistant paroxysmal AF.(J Ceriatr Cardiol 2004;1:29-34.)     

Complete pulmonary vein isolation guided by three-dimensional electroanatomical mapping for the treatment of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy.

AIMS: Evaluation of the clinical outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) and paroxysmal atrial fibrillation (AF) treated with complete pulmonary vein (PV) isolation guided by three-dimensional (3-D) electroanatomical (EA) mapping. METHODS: Circumferential radiofrequency (RF) ablation and continuous circular lesions (CCLs) around the left and right-sided PVs were performed in 4 highly symptomatic patients (2 males; age 57.5 +/- 8.3 years) with HOCM and anti-arrhythmic drug (AAD) refractory paroxysmal AF. Ablation was guided by 3-D EA mapping combined with conventional circumferential PV mapping. The endpoints of the ablation were defined as: (1) absence of all PV spikes documented with the two Lasso catheters within the ipsilateral PVs; and (2) no recurrence of the PV spikes within all PVs following intravenous administration of adenosine. RESULTS: The ablation endpoints were achieved in all patients. A repeat ablation was performed in one patient due to repetitive atrial tachycardia, 1 month after the initial procedure. During a follow-up of 5.8 +/- 2.7 months, all patients are free of AF recurrence. Short episodes of symptomatic AT were documented after the repeat procedure, and were well controlled with oral amiodarone in the patient. No procedure-related complications were observed. CONCLUSION: The present study demonstrates that complete isolation of ipsilateral PVs guided by 3-D EA mapping is potentially effective for the treatment of highly symptomatic, drug refractory paroxysmal AF in patients with HOCM.