ABSTRACT
Circumferential pulmonary vein ablation performing linear lesions around the ostia of the pulmonary veins has been shown to be effective for the treatment of atrial fibrillation. During the follow-up period, persistent atrial tachycardia may occur as a proarrhythmic complication. Only little information is available about the underlying mechanism. In our study, atrial tachycardia following circumferential pulmonary vein ablation was identified in 13 out of 84 consecutive patients (15.5%), as a transient appearance in four and with recurrences for more than 3 months in nine patients (10.7%). Electrophysiological study and ablation was performed in eight cases, revealing common atrial flutter in two, a focal origin secondary to conduction recovery from the pulmonary vein to the left atrium in two and macro reentrant left atrial flutter in four patients. The electrophysiological characteristics demonstrated by electroanatomic activation mapping CARTO and consecutive ablation therapy with a 100% success rate are described and discussed with regard to the literature.
Subject(s)
Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Catheter Ablation/methods , Pulmonary Veins/surgery , Aged , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/mortality , Arrhythmias, Cardiac/surgery , Atrial Fibrillation/mortality , Body Surface Potential Mapping , Cohort Studies , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Monitoring, Intraoperative/methods , Probability , Retrospective Studies , Risk Assessment , Severity of Illness Index , Survival Rate , Treatment OutcomeSubject(s)
Catheter Ablation/adverse effects , Esophageal Fistula/etiology , Fistula/etiology , Heart Atria/injuries , Pulmonary Veins/diagnostic imaging , Tomography, X-Ray Computed , Atrial Fibrillation/surgery , Esophageal Fistula/diagnostic imaging , Fistula/diagnostic imaging , Humans , Male , Middle AgedABSTRACT
BACKGROUND: In some patients with arrhythmias originating from the ventricular outflow tract, catheter ablation may be considered for curative treatment. The conventional ablation procedure may be limited particularly in cases with nonsustained arrhythmias. Only little information is available about three-dimensional electroanatomic mapping combined with the cooled radiofrequency (RF) catheter ablation technique in the treatment of such arrhythmias. PATIENTS AND METHODS: 17 symptomatic and drug-refractory patients were included into this study. Using an electroanatomic mapping system (CARTO), activation mapping was obtained in twelve patients during ventricular tachycardia (VT) or ventricular ectopic beats. In five cases with nonsustained arrhythmias pace mapping during sinus rhythm was performed. The aim was to identify the precise localization of the arrhythmia origin and to abolish its activity by cooled ablation. RESULTS: Procedure time was 117 +/- 35 min, fluoroscopy time totaled 17 +/- 13 min. Ablation was performed with a mean of 7 +/- 5 ablation pulses. In 15 patients (88%) ablation of the clinical VT was acutely successful. During a follow-up of 9 +/- 9 months, two patients had a recurrence of the clinical VT. In one of these cases a successful reablation was performed. No major complications were observed. CONCLUSION: Electroanatomic mapping combined with focal cooled ablation strategy is a safe method to treat ventricular outflow tract arrhythmias effectively.
Subject(s)
Body Surface Potential Mapping/instrumentation , Catheter Ablation/instrumentation , Electrocardiography/instrumentation , Heart Block/surgery , Image Processing, Computer-Assisted/instrumentation , Tachycardia, Ventricular/surgery , Adult , Aged , Cardiac Complexes, Premature/diagnosis , Cardiac Complexes, Premature/physiopathology , Cardiac Complexes, Premature/surgery , Cardiac Pacing, Artificial , Cryotherapy/instrumentation , Female , Follow-Up Studies , Heart Block/diagnosis , Heart Block/physiopathology , Heart Conduction System/physiopathology , Heart Conduction System/surgery , Humans , Male , Middle Aged , Sensitivity and Specificity , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/physiopathologyABSTRACT
In this study, a series of 52 consecutive patients with atrial fibrillation from 1 institution underwent circumferential pulmonary vein ablation using an irrigated-tip catheter. The technique was safe, and 81% of the patients maintained sinus rhythm at 6 months. However, 1/3 of them required additional antiarrhythmic drug therapy.
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/instrumentation , Pulmonary Veins/surgery , Therapeutic Irrigation , Aged , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Catheters, Indwelling , Echocardiography, Transesophageal , Electric Countershock , Electrocardiography, Ambulatory , Electrophysiologic Techniques, Cardiac , Equipment Safety , Heart Conduction System/pathology , Heart Conduction System/surgery , Humans , Middle Aged , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Catheter ablation for ventricular fibrillation in structurally normal hearts is in its infancy. Recently, catheter ablation of idiopathic ventricular fibrillation as well as ventricular fibrillation associated with the long QT and Brugada syndromes has been described. This review article is a summary of our current understanding of the technique and results of catheter ablation of ventricular fibrillation in structurally normal hearts.
