Simultaneous catheter mapping of the pulmonary veins in focal atrial fibrillation: significance of rapid focal activation, effectiveness for catheter ablation.
Most focal atrial fibrillation (AF) is initiated by premature beats from the pulmonary veins (PV), and ablation of these foci can effectively cure AF. We investigated the efficacy of focal ablation and the role of rapid focal activation (RFA) in the maintenance of AF using simultaneous multisite catheter mapping in four PVs. Forty-two patients with frequent attacks of paroxysmal AF were included in the study population. Bipolar electrograms were simultaneously recorded from all four PVs. RFA was determined at AF onset, during sustained AF, or just before the spontaneous termination of AF. RFA was continuously observed not only at a triggered PV, but also at all sites including an opposite non-triggered PV, coronary sinus and high right atrium in sustained AF (>10 minutes), whereas RFA was observed only in the triggered PV and not at the other sites in nonsustained AF. Once RFA ceased, AF terminated immediately. After a mean follow-up of 21 months, focal ablation had eliminated AF without drugs in 24 patients (57%). The technique of simultaneous mapping of the PV using microcatheters is a feasible and effective method for mapping and ablation of focal AF originating from the PV. RFA arising from PVs is important not only as a trigger of onset, but also in the maintenance of AF.
Nakashima
Hideko
H
Department of Cardiology, Fukuoka University School of Medicine, Japan.
Kumagai
Koichiro
K
Tojo
Hideaki
H
Yasuda
Tomoo
T
Noguchi
Hiroo
H
Matsumoto
Naomichi
N
Saku
Keijiro
K
D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology*; D016896:Treatment Outcome