File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Defibrillation-guided radiofrequency ablation of atrial fibrillation secondary to an atrial focus

TitleDefibrillation-guided radiofrequency ablation of atrial fibrillation secondary to an atrial focus
Authors
Issue Date1999
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jac
Citation
Journal Of The American College Of Cardiology, 1999, v. 33 n. 5, p. 1217-1226 How to Cite?
AbstractOBJECTIVES: Our aim was to evaluate a potential focal source of atrial fibrillation (AF) by unmasking spontaneous early reinitiation of AF after transvenous atrial defibrillation (TADF), and to describe a method of using repeated TADF to map and ablate the focus. BACKGROUND: Atrial fibrillation may develop secondary to a rapidly discharging atrial focus that the atria cannot follow synchronously, with suppression of the focus once AF establishes. Focus mapping and radiofrequency (RF) ablation may be curative but is limited if the patient is in AF or if the focus is quiescent. Early reinitiation of AF has been observed following defibrillation, which might have a focal mechanism. METHODS: We performed TADF in patients with drug- refractory lone AF using electrodes in the right atrium (RA) and the coronary sinus. When reproducible early reinitiation of AF within 2 min after TADF was observed that exhibited a potential focal mechanism, both mapping and RF ablation were performed to suppress AF reinitiation. Clinical and ambulatory ECG monitoring was used to assess AF recurrence. RESULTS: A total of 44 lone AF patients (40 men, 4 women; 32 persistent, 12 paroxysmal AF) with a mean age of 58 ± 13 years underwent TADF. Sixteen patients had early reinitiation of AF after TADF, nine (20%; 5 paroxysmal) exhibited a pattern of focal reinitiation. Earliest atrial activation was mapped to the right superior (n = 4) and the left superior (n = 3) pulmonary vein, just inside the orifice, in the seven patients who underwent further study. At the onset of AF reinitiation, the site of earliest activation was 86 ± 38 ms ahead of the RA reference electrogram. The atrial activities from this site were fragmented and exhibited progressive cycle-length shortening with decremental conduction to the rest of the atrium until AF reinitiated. Radiofrequency ablation at the earliest activation site resulted in suppression of AF reinitiation despite pace-inducibility. Improved clinical outcome was observed over 8 ± 4 months' follow-up. CONCLUSIONS: Transvenous atrial defibrillation can help to unmask, map, and ablate a potential atrial focus in patients with paroxysmal and persistent AF. A consistent atrial focus is the cause of early reinitiation of AF in 20% of patients with lone AF, and these patients may benefit from this technique.
Persistent Identifierhttp://hdl.handle.net/10722/162351
ISSN
2015 Impact Factor: 17.759
2015 SCImago Journal Rankings: 10.097
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLau, CPen_US
dc.contributor.authorTse, HFen_US
dc.contributor.authorAyers, GMen_US
dc.date.accessioned2012-09-05T05:19:12Z-
dc.date.available2012-09-05T05:19:12Z-
dc.date.issued1999en_US
dc.identifier.citationJournal Of The American College Of Cardiology, 1999, v. 33 n. 5, p. 1217-1226en_US
dc.identifier.issn0735-1097en_US
dc.identifier.urihttp://hdl.handle.net/10722/162351-
dc.description.abstractOBJECTIVES: Our aim was to evaluate a potential focal source of atrial fibrillation (AF) by unmasking spontaneous early reinitiation of AF after transvenous atrial defibrillation (TADF), and to describe a method of using repeated TADF to map and ablate the focus. BACKGROUND: Atrial fibrillation may develop secondary to a rapidly discharging atrial focus that the atria cannot follow synchronously, with suppression of the focus once AF establishes. Focus mapping and radiofrequency (RF) ablation may be curative but is limited if the patient is in AF or if the focus is quiescent. Early reinitiation of AF has been observed following defibrillation, which might have a focal mechanism. METHODS: We performed TADF in patients with drug- refractory lone AF using electrodes in the right atrium (RA) and the coronary sinus. When reproducible early reinitiation of AF within 2 min after TADF was observed that exhibited a potential focal mechanism, both mapping and RF ablation were performed to suppress AF reinitiation. Clinical and ambulatory ECG monitoring was used to assess AF recurrence. RESULTS: A total of 44 lone AF patients (40 men, 4 women; 32 persistent, 12 paroxysmal AF) with a mean age of 58 ± 13 years underwent TADF. Sixteen patients had early reinitiation of AF after TADF, nine (20%; 5 paroxysmal) exhibited a pattern of focal reinitiation. Earliest atrial activation was mapped to the right superior (n = 4) and the left superior (n = 3) pulmonary vein, just inside the orifice, in the seven patients who underwent further study. At the onset of AF reinitiation, the site of earliest activation was 86 ± 38 ms ahead of the RA reference electrogram. The atrial activities from this site were fragmented and exhibited progressive cycle-length shortening with decremental conduction to the rest of the atrium until AF reinitiated. Radiofrequency ablation at the earliest activation site resulted in suppression of AF reinitiation despite pace-inducibility. Improved clinical outcome was observed over 8 ± 4 months' follow-up. CONCLUSIONS: Transvenous atrial defibrillation can help to unmask, map, and ablate a potential atrial focus in patients with paroxysmal and persistent AF. A consistent atrial focus is the cause of early reinitiation of AF in 20% of patients with lone AF, and these patients may benefit from this technique.en_US
dc.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jacen_US
dc.relation.ispartofJournal of the American College of Cardiologyen_US
dc.rightsJournal of American College of Cardiology. Copyright © Elsevier Inc.-
dc.subject.meshAtrial Fibrillation - Physiopathology - Surgeryen_US
dc.subject.meshCatheter Ablationen_US
dc.subject.meshCatheterization, Central Venousen_US
dc.subject.meshElectric Countershock - Methodsen_US
dc.subject.meshElectrocardiography, Ambulatoryen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPulmonary Veinsen_US
dc.subject.meshRecurrenceen_US
dc.subject.meshSinoatrial Node - Physiopathologyen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleDefibrillation-guided radiofrequency ablation of atrial fibrillation secondary to an atrial focusen_US
dc.typeArticleen_US
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/S0735-1097(98)00691-3en_US
dc.identifier.pmid10193719-
dc.identifier.scopuseid_2-s2.0-0033117192en_US
dc.identifier.hkuros40671-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0033117192&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume33en_US
dc.identifier.issue5en_US
dc.identifier.spage1217en_US
dc.identifier.epage1226en_US
dc.identifier.isiWOS:000081065600015-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridLau, CP=7401968501en_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.scopusauthoridAyers, GM=7102015157en_US

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats