Abstract 19031: Prediction and Incidence of Non-PV Trigger Foci of Atrial Fibrillation With Regard to Clinical Profile

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yasushi Mukai ◽  
Shujiro Inoue ◽  
Susumu Takase ◽  
Shunsuke Kawai ◽  
Akiko Chishaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcome ◽  
Superior Vena ◽  
Vena Cava ◽  
Atrial Pacing ◽  
Spontaneous Firing ◽  
Ablation Procedure ◽  
Clinical Background ◽  
Clinical Profiles ◽  
Af Recurrence

Introduction: Non-PV triggers play significant roles in initiating atrial fibrillation (Af). We hypothesized that location of non-PV Af triggers is predictable to some extent from clinical background and may have influence on clinical outcome after ablation. Methods: We analyzed consecutive 109 patients (76 men) with Af who underwent catheter ablation and investigation of Af triggers. Af was induced under recordings of intra-cardiac electrograms before ablation procedure in the following ways (1) watching spontaneous firing, (2) induction with intravenous infusion of isoproterenol and adenosine, (3) burst atrial pacing and/or intentional defibrillation to watch immediate recurrence of Af. Af triggers were analyzed and compared to clinical profiles and therapeutic outcome. Results: Eighty-four were paroxysmal Af and 25 were persistent. Any ectopic trigger of Af was identified in 73 patients (66%) with 99 foci. Seventy-eight foci were PVs (79%) whereas 21 (21%) were non-PV triggers. In general, non-PV foci were notably identified in female (P<0.01) whereas age, LA diameter or Af type was not significantly relevant to the presence of non-PV foci. Among non-PV foci, superior vena cava (SVC, n=5), crista terminals (CT, n=5) and left atrium (LA, n=5) were prevalent sites. CT was prevalently noted in younger females (P<0.01), whereas SVC was regardless of age. Non-PV foci in the LA were preferably noted in patients with persistent Af (P<0.05). Importantly, multiple or non-PV foci were not significantly correlated to Af recurrence after ablation, whereas LA diameter was weakly correlated. Conclusion: Presence and sites of non-PV foci are rather predictable by simple clinical profiles such as gender, age and type of Af. Multiple or non-PV foci may not be associated with worse clinical outcome as long as they can be successfully targeted and ablated.

Thoracic vein ablation terminates chronic atrial fibrillation in dogs

2004 ◽  
Vol 286 (6) ◽  
pp. H2072-H2077 ◽  
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.

scholarly journals A case report of pulmonary vein isolation with radiofrequency catheter using superior vena cava approach in patient with paroxysmal atrial fibrillation and inferior vena cava filter

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Masatoshi Narikawa ◽  
Masayoshi Kiyokuni ◽  
Junya Hosoda ◽  
Toshiyuki Ishikawa
Keyword(s):  
Atrial Fibrillation ◽  
Inferior Vena Cava ◽  
Left Atrium ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Transseptal Puncture ◽  
Mapping Catheter ◽  
Steerable Sheath

Abstract Background Transseptal puncture and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are generally performed via the inferior vena cava (IVC). However, in cases where the IVC is inaccessible, a specific strategy may be needed. Case summary An 86-year-old woman with paroxysmal AF and an IVC filter in situ was referred to our hospital for ablation therapy. An IVC filter for pulmonary embolism and deep venous thrombosis had been implanted 15 years prior, therefore we selected a transoesophageal echocardiography (TOE)-guided transseptal puncture using a superior vena cava (SVC) approach. After the single transseptal puncture, we performed fast anatomical mapping, voltage mapping by multipolar mapping catheter, and then PVI by contact force-guided radiofrequency catheter using a steerable sheath. Following the ablation, bidirectional conduction block between the four pulmonary veins and the left atrium was confirmed by both radiofrequency and mapping catheter. No complications occurred and no recurrence of AF was documented in the 12 months after the procedure. Discussion When performing a transseptal puncture during AF ablation, an SVC approach, via access through the right internal jugular vein, enables the sheath to directly approach the left atrium without angulation and improves operability of the ablation catheter. Combining the use of general anaesthesia, TOE, a steerable sheath, and contact force-guided ablation may contribute to achieving minimally invasive PVI with a single transseptal puncture via an SVC approach.

Electrophysiological Properties of the Superior Vena Cava and Venoatrial Junction in Patients with Atrial Fibrillation

2013 ◽  
Vol 25 (1) ◽  
pp. 16-22 ◽  
Author(s):  
KOTARO FUKUMOTO ◽  
SEIJI TAKATSUKI ◽  
TAKEHIRO KIMURA ◽  
NOBUHIRO NISHIYAMA ◽  
KOJIRO TANIMOTO ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Electrophysiological Properties

Sinus Node Injury as a Result of Superior Vena Cava Isolation during Catheter Ablation for Atrial Fibrillation and Atrial Flutter

2010 ◽  
Vol 34 (2) ◽  
pp. 163-170 ◽  
Author(s):  
GANG CHEN ◽  
JIAN ZENG DONG ◽  
XING PENG LIU ◽  
XIN YONG ZHANG ◽  
DE YONG LONG ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Sinus Node ◽  
Vena Cava

Selective parasympathectomy of automatic and conductile tissues of the canine heart

1985 ◽  
Vol 248 (1) ◽  
pp. H61-H68 ◽  
Author(s):  
W. C. Randall ◽  
J. L. Ardell
Keyword(s):  
Vagal Stimulation ◽  
Superior Vena ◽  
Sympathetic Innervation ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Dorsal Surface ◽  
Atrial Pacing ◽  
Canine Heart ◽  
Surgical Interventions ◽  
The Right

From right thoracotomy (T4-T5), the canine heart was suspended in its pericardium to expose its major venous inputs. Vagal and sympathetic trunks were prepared for electrical stimulation (10-20 Hz, 5.0 ms, 3-5 V) before and after each separate denervation procedure. Vagal stimulation was instituted with and without concurrent atrial pacing. The following surgical interventions were performed. 1) The superior vena cava was cleared of connective and nervous tissues from the pericardial reflection caudally to the level of the right pulmonary artery. 2) The azygos vein was cleared, tied, and sectioned. 3) The right pulmonary veins were isolated and cleared intrapericardially. 4) The dorsal surface of the atria was dissected between the right and left pulmonary veins and painted with phenol. Each step in the procedure elicited successive stepwise deletion of parasympathetic influences on sinoatrial tissues of the canine heart with only minor ablation of sympathetic inputs. 5) Dissection of the triangular fat pad at the junction of the inferior vena cava and inferior left atrium eliminated the remaining parasympathetic efferent input to the heart with dramatic deletion of atrioventricular block during either left or right vagal stimulation, again with preservation of most of the sympathetic innervation. These experiments clearly demonstrate differential and selective inputs of parasympathetic pathways to sinoatrial (SAN) and atrioventricular (AVN) regions of the dog heart but relatively little interference with sympathetic distributions.(ABSTRACT TRUNCATED AT 250 WORDS)

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