Radiofrequency Pulmonary Vein Isolation in a Patient with Dextrocardia With Situs Inversus Totalis.

Background: We present a case report of a 67-year-old male with dextrocardia situs inversus totalis and persistent atrial fibrillation who presented for radiofrequency pulmonary vein isolation.

Methods: Pulmonary vein isolation was performed using the St Jude Medical Ensite NavX 3D mapping system with AccuNav ICE guidance.

Results: All pulmonary veins were successfully isolated.

Localized reentry within the left atrial appendage: arrhythmogenic role in patients undergoing ablation of persistent atrial fibrillation.

Background: Left atrial appendage (LAA) is implicated in maintenance of atrial fibrillation (AF) and atrial tachycardia (AT) associated with persistent AF (PsAF) ablation, although little is known about the incidence and mechanism of LAA AT.

Objective: The purpose of this study was to characterize LAA ATs associated with PsAF ablation.

Methods: In 74 consecutive patients undergoing stepwise PsAF ablation, 142 ATs were encountered during index and repeat procedures.

Tachycardia transition during ablation of persistent atrial fibrillation.

Background: The "sequential ablation" strategy for persistent AF is aimed at progressive organization of AF until the rhythm converts to sinus rhythm or atrial tachycardia (AT). During ablation of an AT, apparently seamless transitions from one organized AT to another occur. The purpose of our study was to quantify the occurrence and the mechanism of this transition.

Peri-mitral atrial flutter in patients with atrial fibrillation ablation.

Background: Peri-mitral atrial flutter (PMFL) is commonly encountered in patients undergoing atrial fibrillation (AF) ablation.

Objective: The purpose of this study was to determine the electrophysiologic characteristics, procedural success, and medium-term outcomes in patients with PMFL.

Methods: The study consisted of 50 consecutive patients (45 men and 5 women, age 57 +/- 12 years) with PMFL following or during AF ablation.

Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation.

Objectives: This study evaluated the role of pre-procedural clinical variables to predict procedural and clinical outcomes of catheter ablation in patients with long-lasting persistent atrial fibrillation (AF).

Background: Catheter ablation of persistent AF remains a challenging task.

Methods: Catheter ablation was performed in 90 patients (76 men, age 57 +/- 11 years) with long-lasting persistent AF.

Clinical value of fibrillatory wave amplitude on surface ECG in patients with persistent atrial fibrillation.

Purpose: We postulated that amplitude of fibrillatory (F)-wave in patients with persistent AF would correlate with clinical characteristics and outcome in patients undergoing catheter ablation for AF.

Method: Maximal and mean amplitude of F-waves were measured in V1 and lead II in 90 patients prior to ablation for persistent AF. F-wave amplitudes were correlated to clinical, echocardiographic variables, and outcome.

Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint.

Aims: Catheter ablation of long-lasting persistent atrial fibrillation (AF) has been performed with varying results using a combination of different techniques. Whether arrhythmia termination during ablation is associated with an improved clinical outcome is controversial.

Methods And Results: In this prospective study, 153 consecutive patients (56 +/- 10 years) underwent catheter ablation of persistent AF (25 +/- 33 months) using a stepwise approach with the desired procedural endpoint being AF termination.

Imaging in catheter ablation for atrial fibrillation: enhancing the clinician's view.

Catheter ablation is an effective treatment for symptomatic atrial fibrillation. A thorough understanding of the left atrium anatomy and its adjacent structures is critical for the success of the procedure and for avoiding complications. Pre-procedural imaging aims at determining left atrial size, anatomy, and function and is also used to rule out an atrial thrombus.

Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation.

Aims: This study evaluates the clinical outcome and incidence of left atrial (LA) macro re-entrant atrial tachycardia (AT) in patients in whom persistent atrial fibrillation (AF) terminated during catheter ablation without the need of roof and mitral lines.

Methods And Results: Persistent AF was terminated by ablation in 154 of 180 consecutive patients. AF history was 60 months including 11 months of continuous AF.

Early recurrences after atrial fibrillation ablation: prognostic value and effect of early reablation.

Introduction: Early arrhythmia recurrences are common within the first month after atrial fibrillation (AF) ablation. The long-term consequences of these early recurrences (ER) are controversial. We investigated whether ER were predictive of late recurrences and the impact of early reablation on clinical outcome.

Maintenance of atrial fibrillation by pulmonary vein tachycardia with ostial conduction block: evidence of an interpulmonary vein electrical connection.

We report a case of a 56-year-old man with paroxysmal atrial fibrillation who underwent segmental, ostial pulmonary vein (PV) isolation while in arrhythmia. During isolation of the left superior PV (LSPV), organized electrical activity was seen within the vein, suggestive of a PV tachycardia with a cycle length of 90 ms. Simultaneously, organized electrical activity with a cycle length of 180 ms was seen in the left inferior PV (LIPV), suggestive of 2:1 conduction between the LSPV and the LIPV.

Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation.

Objectives: This study sought to determine the characteristics of atrial electrograms predictive of slowing or termination of atrial fibrillation (AF) during ablation of chronic AF.

Background: There is growing recognition of a role for electrogram-based ablation.

Methods: Forty consecutive patients (34 male, 59 +/- 10 years) undergoing ablation for chronic AF persisting for a median of 12 months (range 1 to 84 months) were included.

Relationship between perimitral and peritricuspid conduction times.

Background: Conduction block across the left mitral isthmus (LMI) seems more challenging to achieve and validate compared with the cavotricuspid isthmus (CTI).

Objective: This study sought to investigate the relationship between peritricuspid and perimitral circuit times in the same patient and to compare the difficulty in achieving the CTI and LMI linear lesions.

Methods: We retrospectively studied 122 consecutive patients (46 paroxysmal and 76 persistent) admitted for atrial fibrillation ablation or subsequent atrial macroreentry who underwent both CTI and LMI ablation.

Dual independent atrial tachycardias after ablation of chronic atrial fibrillation.

We report the case of a 71-year-old man with two atrial tachycardias evolving simultaneously and independently in two dissociated regions after extensive ablation for chronic atrial fibrillation. One tachycardia was a focal tachycardia originating from the right inferior pulmonary vein and activating the posterior left atrium with a 2:1 conduction block, while the other tachycardia was an atrial flutter circulating around the tricuspid annulus, activating the right atrium and the anterior wall of the left atrium. These two atrial tachycardias were successfully ablated prior to restoration of sinus rhythm.

Atrial fibrillatory cycle length: computer simulation and potential clinical importance.

Aims: Atrial fibrillatory cycle length (AFCL) is generally accepted as a surrogate marker for local refractoriness. In this study, a computer model and clinical data on human subjects undergoing catheter ablation for paroxysmal and persistent AF were used to determine the clinical potential of AFCL.

Methods And Results: Simulations were performed in a biophysical computer model of AF, induced from eight simultaneously active focal sources.

Cycle length dependent block in the "mitral-pulmonary vein" isthmus.

We report a case of cycle length dependent activation sequence in the coronary sinus catheter during assessment of mitral-pulmonary vein isthmus block. A 61-year-old patient presented with atrial tachycardia following a recent pulmonary vein isolation for paroxysmal atrial fibrillation. A perimitral macroreentrant atrial tachycardia was demonstrated during mapping.

Focal arrhythmia confined within the coronary sinus and maintaining atrial fibrillation.

Introduction: The coronary sinus (CS) is a complex structure comprising a mesh of circumferential muscular fibers with oblique connections to both atria. We describe further evidence for the clinical importance of CS arrhythmogenicity in maintaining atrial fibrillation (AF) in humans.

Methods: Since January 2004, following a sequential approach, the CS and the inferior left atrium were ablated in 144 patients with symptomatic drug refractory AF.

Catheter ablation of persistent and permanent atrial fibrillation: Bordeaux experience.

The seminal observation that ectopics from the pulmonary veins may initiate paroxysmal atrial fibrillation (AF) heralded an era of potentially curative catheter ablation therapy for AF. In recent years, catheter ablation has been performed for not only paroxysmal but also persistent and permanent AF. It is anticipated that the number of procedures will continue to increase and the indication for catheter ablation will expand.