e0562 Impact of circumferential pulmonary vein isolation on electrophysiologic properties of pulmonary veins in patients with paroxysmal atrial fibrillation

Abstract Introduction The effect of circumferential pulmonary vein isolation (PVI) for atrial fibrillation (AF) on left atrial (LA) function has not been well defined. Purpose The aim of this study was to evaluate the immediate impact of ablation on parameters of global and regional LA function using intracardiac echocardiography (ICE) Methods We studied 26 consecutive patients (age 56±10 years, 19 men) with paroxysmal AF using ICE before and immediately after circumferential PVI. All pulmonary veins were isolated in all patients. ICE measurements included LA fractional area shortening, peak A wave on transmitral Doppler flow, peak emptying velocity on the left atrial appendage (LAA) Doppler flow, as well as tissue Doppler myocardial velocities at the level of the posterior LA wall, interatrial septum, and lateral wall, which were used as parameters of regional LA function. Results The mean radiofrequency ablation time was 37±22min. Post ablation there was a significant reduction of the LA fractional area shortening from 27±8% to 22±6% (p<0.01). The tissue Doppler velocity of atrial contraction at the posterior wall decreased significantly post ablation: from 8.9±1.8 cm/s to 6.9±1.4 cm/s (p<0.01). There were no significant differences between the pre and post ablation values for tissue Doppler velocities at the level of the interatrial septum or LA lateral wall. The post ablation peak transmitral A wave and peak LAA Doppler velocities did not differ significantly from the pre ablation values. Conclusion In patients with paroxysmal atrial fibrillation, circumferential PVI results in an immediate decrease in LA function without a significant change in LAA function.

Download Full-text

P1415Wide antral circumferential pulmonary vein isolation ablation using a novel balloon cryoablation catheter

EP Europace ◽

10.1093/europace/euaa162.203 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A P Martin ◽

M Fowler ◽

N Lever

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Pulmonary Veins ◽

Posterior Wall ◽

The Novel ◽

Median Treatment

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated. Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.

Download Full-text

Initial Experience with Robotic Epicardial Off-Pump Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01.imi.0000235467.09577.65 ◽

2006 ◽

Vol 1 (5) ◽

pp. 247-250

Author(s):

Filip Casselman ◽

Ihsan Bakir ◽

Pedro Brugada ◽

Peter Geelen ◽

Francis Wellens ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Pulmonary Veins ◽

Median Sternotomy ◽

Transverse Sinus ◽

Right Atrial ◽

Off Pump

Objective To evaluate the feasibility and results of isolated endoscopic pulmonary vein isolation for paroxysmal atrial fibrillation using robotics. Methods Between November 2004 and December 2005, 13 patients (38.5% female) underwent robotic pulmonary vein isolation at our institution. Mean age was 46.8 ± 8.4 years and mean preoperative duration of atrial fibrillation was 52.7 ±31.5 months. Indication for surgery was symptomatic drug-refractory paroxysmal atrial fibrillation or recurrence after percutaneous treatment (n = 3). Mean preoperative left atrial dimension was 38.5 ± 6.9 mm. The surgical procedure was performed off-pump as an isolated right chest approach. All procedures were performed using the Flex 10 microwave ablator (Guidant, Indianapolis, IN), which was positioned from the right side through the transverse sinus and around the 4 pulmonary veins. Postoperative drug regimen included sotalol and Coumadin. Mean follow-up was 8.5 ± 3.4 months. Results The procedure was successful in 11 patients. One patient needed conversion to median sternotomy for right pulmonary artery bleeding and a second patient had severe transverse sinus adhesions requiring conversion to a bilateral video-assisted small thoracotomy approach. No other morbidity occurred. Mean procedure time in successful cases was 2.7 ± 0.8 hours (range 1.7 to 4 hours). Permanent sinus rhythm was successfully restored in 10 of 13 patients (76.9% beyond 6 months). Nonsuccessful patients had markedly reduced symptoms and frequency of events. One patient required a left and another a right atrial flutter ablation during follow-up. Conclusions Robotic pulmonary vein isolation is a feasible procedure that has the potential to become a valid option in the treatment of paroxysmal atrial fibrillation.

Download Full-text

Does additional linear ablation after circumferential pulmonary vein isolation improve clinical outcome in patients with paroxysmal atrial fibrillation? Prospective randomised study

Heart ◽

10.1136/heartjnl-2011-301107 ◽

2012 ◽

Vol 98 (6) ◽

pp. 480-484 ◽

Cited By ~ 36

Author(s):

Hee-Sun Mun ◽

Boyoung Joung ◽

Jaemin Shim ◽

Hye Jin Hwang ◽

Jong Youn Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Randomised Study ◽

Linear Ablation ◽

Improve Clinical Outcome ◽

Prospective Randomised Study ◽

Circumferential Pulmonary Vein Isolation

Download Full-text

Endurance Ablation Facilitates Long-lasting Circumferential Pulmonary Vein Isolation and Better Clinical Outcomes in Patients with Paroxysmal Atrial Fibrillation

International Journal of Arrhythmia ◽

10.18501/arrhythmia.2017.020 ◽

2017 ◽

Vol 18 (3) ◽

pp. 121-132

Author(s):

Hee Tae Yu ◽

Junbeom Park ◽

Tae-Hoon Kim ◽

Jae-Sun Uhm ◽

Jong-Youn Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcomes ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Circumferential Pulmonary Vein Isolation

Download Full-text

Prospective Randomized Clinical Trial of Wide Area Circumferential Pulmonary Vein Ablation versus Segmental Pulmonary Vein Ablation for Pulmonary Vein Isolation as a Treatment for Short-Duration Paroxysmal Atrial Fibrillation

10.22541/au.161196037.76727054/v1 ◽

2021 ◽

Author(s):

Sapan Bhuta ◽

Gustaf Sverin ◽

Hiro Kawata ◽

Malek Bashti ◽

Jessica Hunter ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Pulmonary Veins ◽

Wide Area ◽

Pulmonary Vein Ablation ◽

Total Procedure Time

Background: Previous studies suggest that wide area circumferential pulmonary vein ablation (WACA) is more effective than segmental pulmonary vein ablation (SPVA) for pulmonary vein isolation (PVI) for treatment of atrial fibrillation. Whether this is true in patients (pts) with very short duration paroxysmal atrial fibrillation (PAF) is unknown. Objective: To compare WACA to SPVA in pts with PAF lasting <48 hours. Methods: One hundred pts with PAF <48 hours were randomized to either WACA vs SPVA (45 and 53 pts respectively, with 2 withdrawals), and followed up for 24 months with 14-day ECGs every 6 months. Results: Among 97 pts at an average of 22.1±4.8 months followup, 26 (57.8%) remained free of any atrial arrhythmias after WACA versus 29 (55.86%) after SPVA (p=0.64). Sixteen pts (35.6%) had recurrent PAF after WACA versus 20 pts (38.5%) after SPVA (p=0.79). Seven pts (15.6%) had atrial flutter after WACA versus 5 pts (9.64%) after SPVA (p=0.376) and 1 pt (2.2%) had atrial tachycardia after WACA vs 1 pt (1.9%) after SPVA (p=0.918). Total procedure time was lower for SPVA vs WACA (242.9 vs 271.1 minutes, p= 0.047), and fluoroscopy time similar for WACA vs SPVA (50.8 vs 53.4 minutes, p=0.555). Conclusions: As an initial ablation approach in pts with PAF <48 hours, SPVA was similarly effective to WACA with respect to arrhythmia recurrence, supporting the central role of the pulmonary veins for maintaining AF in these pts. Future therapies using alternative ablation energies may incorporate these insights to reduce risk to gastroesophageal structures.

Download Full-text