Comparison of expression of connexin in right atrial myocardium in patients with chronic atrial fibrillation versus those in sinus rhythm

Objective Transmural and contiguous ablations and a comprehensive lesion pattern are difficult to create from the surface of a beating heart but are critical to the successful treatment of persistent, isolated atrial fibrillation. A codisciplinary simultaneous epicardial (surgical) and endocardial (catheter) procedure (Convergent procedure) addresses these issues. Methods Patients with symptomatic atrial fibrillation who failed medical treatment were evaluated. Using only pericardioscopy, the surgeon performed near-complete epicardial isolation of the pulmonary veins and a “box” lesion on the posterior left atrium using unipolar radiofrequency ablation. Simultaneous endocardial catheter radiofrequency ablation completed pulmonary vein isolation, performed a mitral annular and cavotricuspid isthmus line of block, and debulked the coronary sinus. Twelve-month results for the Convergent procedure were compared with 12-month results for concomitant and pericardioscopic (stand-alone transdiaphragmatic/thoracoscopic) atrial fibrillation procedures using unipolar radiofrequency ablation. Results Sixty-five patients underwent the Convergent procedure (mean age, 62 y; mean body surface area, 2.17 m2; mean atrial fibrillation duration, 4.8 y; mean left atrial size, 5.2 cm). Ninety-two percent were in persistent or long-standing persistent atrial fibrillation. At 12 months, evaluation with 24-hour Holter monitors found 82% of patients in sinus rhythm, while only 47% of pericardioscopic and 77% of concomitant patients treated with unipolar radiofrequency ablation were in sinus rhythm. Conclusions Simultaneous epicardial and endocardial ablation improves outcomes for patients with persistent or longstanding persistent atrial fibrillation. This successful collaboration between cardiac surgeon and electrophysiologist is an important treatment option for patients with large left atriums and chronic atrial fibrillation.

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Post-operative atrial fibrillation is associated with a pre-existing structural and electrical substrate in human right atrial myocardium

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.06.249 ◽

2016 ◽

Vol 220 ◽

pp. 580-588 ◽

Cited By ~ 16

Author(s):

Junaid A.B. Zaman ◽

Leanne Harling ◽

Hutan Ashrafian ◽

Ara Darzi ◽

Nigel Gooderham ◽

...

Keyword(s):

Atrial Fibrillation ◽

Right Atrial ◽

Atrial Myocardium ◽

Human Right ◽

Post Operative Atrial Fibrillation

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Conversion of chronic atrial fibrillation to sinus rhythm with combined propranolol and quinidine treatment

American Heart Journal ◽

10.1016/0002-8703(67)90274-8 ◽

1967 ◽

Vol 74 (2) ◽

pp. 170-172 ◽

Cited By ~ 37

Author(s):

Shlomo Stern

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Chronic Atrial Fibrillation

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Thoracic vein ablation terminates chronic atrial fibrillation in dogs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00595.2003 ◽

2004 ◽

Vol 286 (6) ◽

pp. H2072-H2077 ◽

Cited By ~ 13

Author(s):

Angela M. Park ◽

Chung-Chuan Chou ◽

Paul C. Drury ◽

Yuji Okuyama ◽

Anish Peter ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Chronic Atrial Fibrillation ◽

Atrial Pacing ◽

Bipolar Electrodes ◽

Cycle Lengths ◽

Activation Cycle

The thoracic vein hypothesis of chronic atrial fibrillation (AF) posits that rapid, repetitive activations from muscle sleeves within thoracic veins underlie the mechanism of sustained AF. If this is so, thoracic vein ablation should terminate sustained AF and prevent its reinduction. Six female mongrel dogs underwent chronic pulmonary vein (PV) pacing at 20 Hz to induce sustained (>48 h) AF. Bipolar electrodes were used to record from the atria and thoracic veins, including the vein of Marshall, four PVs, and the superior vena cava. Radio frequency (RF) application was applied around the PVs and superior vena cava and along the vein of Marshall until electrical activity was eliminated. Computerized mapping (1,792 electrodes, 1 mm resolution) was also performed. Sustained AF was induced in 30.6 ± 6.5 days, and ablation was done 17.3 ± 8.5 days afterward. Before ablation, the PVs had shorter activation cycle lengths than the atria, and rapid, repetitive activations were observed in the PVs. All dogs converted to sinus rhythm during ( n = 4 dogs) or within 90 min of completion of RF ablation. Rapid atrial pacing afterward induced only nonsustained (<60 s) AF in all dogs. Average AF cycle lengths after reinduction were significantly ( P = 0.01) longer (183 ± 31.5 ms) than baseline (106 ± 16.2 ms). There were no activation cycle length gradients after RF application. We conclude that thoracic vein ablation converts canine sustained AF into sinus rhythm and prevents the reinduction of sustained AF. These findings suggest that thoracic veins are important in the maintenance of AF in dogs.

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