New approach to pulmonary vein isolation for atrial fibrillation using a multielectrode basket catheter.
BACKGROUND
Pulmonary vein (PV) isolation using a circular catheter creates an entrance block from the left atrium (LA) to the PV, which eliminates paroxysmal atrial fibrillation (PAF). A new approach to PV isolation during distal PV pacing is to use a basket catheter.


RESULTS
Fifty consecutive patients with PAF underwent basket-catheter-guided PV isolation. PV pacing was performed from the distal electrode pair of the basket catheter. The exit breakthrough point was targeted for segmental PV isolation. The endpoint was the elimination of bidirectional PV - LA conduction. A repeat ablation procedure was performed in 12 of 14 patients who had recurrence of AF. The recovery of PV -LA conduction was noted in 24 of the 48 PVs, and 5 PVs (21%) had unidirectional block. At 12 months, 80% of patients were free of AF without antiarrhythmic drugs. No PV stenosis >50% was detected at 12 months after the procedure.


CONCLUSIONS
This new approach for PV isolation during distal PV pacing using a basket catheter is useful for confirming bidirectional PV - LA conduction block. PV isolation that creates not only an entrance block but also an exit block at the PV - LA junction may be required to cure paroxysmal AF.
Kumagai
Koichiro
K
Department of Cardiology, Fukuoka University Hospital, Japan. kxk@fukuoka-u.ac.jp
Noguchi
Hiroo
H
Ogawa
Masahiro
M
Nakashima
Hideko
H
Zhang
Bo
B
Miura
Shin-ichiro
S
Saku
Keijiro
K
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D004558:Electric Stimulation; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D012008:Recurrence; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin