Very long term outcome after linear versus electrogram guided ablation for persistent atrial fibrillation.

The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n = 52) and one with PVI and EGM-guided ablation (EGM-group; n = 52).

Filling defects of the left atrial appendage on multidetector computed tomography: their disappearance following catheter ablation of atrial fibrillation and the detection of LAA thrombi by MDCT.

Filling defects of the left atrial appendage (LAA) on multidetector computed tomography (MDCT) are known to occur, not only due to LAA thrombi formation, but also due to the disturbance of blood flow in the LAA of patients with atrial fibrillation (AF). The purpose of this study was to evaluate the impact of the maintenance of sinus rhythm via ablation on the incidence of LAA filling defects on MDCT in patients with AF. A total of 459 consecutive patients were included in the present study.

Influence of the concomitant use of heparin on the effects of warfarin during catheter ablation for atrial fibrillation.

Warfarin is widely used to perform catheter ablation for atrial fibrillation (AF). Heparin is usually administered during this procedure to prevent thromboembolic events, while protamine is used to reduce the incidence of bleeding complications. The purpose of this study was to investigate the influence of heparin and protamine administration on the effects of warfarin and its safety.

Predictors of ectopic firing from the superior vena cava in patients with paroxysmal atrial fibrillation.

Purpose: Although catheter ablation targeting the pulmonary vein (PV) is a well-known therapy for patients with paroxysmal atrial fibrillation (PAF), ectopic firings from the superior vena cava (SVC) can initiate PAF. The purpose of this study was to investigate predictors of SVC firing.

Methods: The subjects included 336 consecutive PAF patients (278 males, age 56.

[Nonspecific reacting materials that interferes tacrolimus assay by ACMIA].

We report two cases of falsely elevated levels of Tacrolimus (TAC) measured by affinity column mediated immunoassay (ACMIA). Potential reasons for this are herein explored. Patient 1, a post-renal transplantation patient, was treated by TAC, while patient 2, a patient with rheumatoid arthritis, was not.

The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up.

Aims: Although patients with paroxysmal atrial fibrillation (AF) and prolonged sinus pauses [tachycardia-bradycardia syndrome (TBS)] are generally treated by permanent pacemaker, catheter ablation has been reported to be a curative therapy for TBS without pacemaker implantation. The purpose of this study was to define the potential role of successful ablation in patients with TBS.

Methods And Results: Of 280 paroxysmal AF patients undergoing ablation, 37 TBS patients with both AF and symptomatic sinus pauses (age: 62 ± 8 years; mean maximum pauses: 6 ± 2 s) were analysed.

Substrate modification by pulmonary vein isolation and left atrial linear ablation in patients with persistent atrial fibrillation: its impact on complex-fractionated atrial electrograms.

Unlabelled: PV and Linear Ablation for CFAEs. 

Introduction: Linear ablations in the left atrium (LA), in addition to pulmonary vein (PV) isolation, have been demonstrated to be an effective ablation strategy in patients with persistent atrial fibrillation (PsAF). This study investigated the impact of LA linear ablation on the complex-fractionated atrial electrograms (CFAEs) of PsAF patients.

Improvement of atrioventricular conduction following catheter ablation of atrioventricular nodal reentry tachycardia in a patient with a prolonged PR interval.

We herein present the case of a 60-year-old male with narrow QRS tachycardia who had a remarkable PR prolongation during sinus rhythm. The tachycardia was diagnosed as a slow-fast atrioventricular nodal reentry tachycardia. Slow pathway ablation was performed after the confirmation of the presence of an antegrade fast pathway.

Real-time dominant frequency analysis of the pulmonary vein in patients with paroxysmal atrial fibrillation.

Background: Paroxysmal atrial fibrillation (PAF) can be treated with pulmonary vein isolation (PVI). A spectral analysis can identify sites of high-frequency activity during atrial fibrillation (AF). We investigated the role of the PVs on AF perpetuation by dominant frequency (DF) analysis.

Repeated provocation of time- and ATP-induced early pulmonary vein reconnections after pulmonary vein isolation: eliminating paroxysmal atrial fibrillation in a single procedure.

Background: Recurrence of atrial fibrillation (AF) after successful pulmonary vein isolation (PVI) occurs mainly due to the reconnection of the once isolated PV. Although provocation and elimination of the early pulmonary vein reconnection (EPVR) soon after PVI has been widely performed to improve the outcome, AF recurrence due to subsequent PV reconnections still occurs. In this study, we repeatedly provoked and eliminated the EPVR to determine the appropriate procedural end point.

Completion of mitral isthmus ablation using a steerable sheath: prospective randomized comparison with a nonsteerable sheath.

Background: Although mitral isthmus (MI) ablation in atrial fibrillation (AF) patients has been shown to be an effective ablative strategy, the establishment of the bidirectional conduction block of the MI is technically challenging. We investigated the usefulness of a steerable sheath for MI ablation in patients with persistent AF and its impact on the clinical outcome of persistent AF ablation.

Methods: A total of 80 consecutive patients undergoing MI ablation were randomized to 1 of the following 2 groups: group S (using a steerable long sheath) or group NS (using a nonsteerable long sheath).

Different strategies for performing pulmonary vein isolation in patients with pulmonary vein rhythm.

Pulmonary vein (PV) isolation was performed in atrial fibrillation (AF) patients whose cardiac rhythm was dominated by the ectopic beats originating from the PV. We herein report two cases with dominant PV ectopic rhythm that underwent catheter ablation for the treatment of paroxysmal AF. In one case, a permanent pacemaker implantation was required to treat a symptomatic long sinus pause after the isolation of all four PVs, while no AF was documented during the 5-year period after ablation.

Dormant pulmonary vein conduction induced by adenosine in patients with atrial fibrillation who underwent catheter ablation.

Background: intravenous administration of adenosine triphosphate (ATP) is used to induce transient pulmonary vein (PV) reconduction (dormant PV conduction) following PV isolation. This study investigated the detailed characteristics of dormant PV conduction in patients with atrial fibrillation (AF) who underwent catheter ablation.

Methods: two hundred sixty consecutive patients (235 men; mean age, 54 ± 10 years) who underwent catheter ablation of their AF were included in this study.

Identification of a conduction gap of the mitral isthmus by using a novel high-density mapping catheter.

Peri-mitral atrial flutter, which is a type of macroreentrant atrial tachycardia circulating around the mitral annulus, was terminated with the guidance of the high-density mapping catheter. A 72-year-old woman with atrial fibrillation and atrial tachycardia presented with symptoms of congestive heart failure. The recurrent peri-mitral atrial flutter following the initial catheter ablation for atrial tachycardia and atrial fibrillation was terminated by radiofrequency application on the gap that was identified using a novel high-density mapping catheter.

Comparison of the clinical outcome after pulmonary vein isolation based on the appearance of adenosine-induced dormant pulmonary vein conduction.

Background: The elimination of transient pulmonary vein (PV) reconduction (dormant PV conduction) revealed by adenosine in addition to PV isolation reduced the atrial fibrillation (AF) recurrence after catheter ablation. The dormant PV conduction is induced in approximately half of the AF patients that undergo PV isolation. The present study compared the clinical outcome of AF ablation in patients whose dormant PV conduction was eliminated by additional radiofrequency applications with the outcome in patients without dormant conduction.

Prospective randomized comparison of a steerable versus a non-steerable sheath for typical atrial flutter ablation.

Aims: Although cavotricuspid isthmus (CTI) ablation can cure typical atrial flutter (AFL), it might be difficult to achieve a bidirectional conduction block in the isthmus in some patients. We investigated the usefulness of a steerable sheath for CTI ablation in patients with typical AFL or atrial fibrillation.

Methods And Results: A total of 40 consecutive patients (36 males; mean age 55.

Acute progression of congestive heart failure during paroxysmal supraventricular tachycardia in a patient without structural heart disease.

This report presents the case of a 48-year-old male with acute congestive heart failure caused by paroxysmal supraventricular tachycardia. The patient showed no structural heart disease with normal echocardiography parameters of the left ventricle. The pulmonary capillary wedge pressure (PCWP) was continuously monitored during the electrophysiological study.

Impact of pulmonary vein isolation on the autonomic modulation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses.

Aims: The efficacy of catheter-based pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and prolonged sinus pauses [bradycardia-tachycardia syndrome (BTS)] has been already described. However, the effects of PVI on autonomic modulation in BTS patients remain to be determined. We, therefore, examined the alteration in the autonomic modulation through the PVI procedure by using a heart rate variability (HRV) analysis of 24 h ambulatory monitoring.

The dormant epicardial reconnection of pulmonary vein: an unusual cause of recurrent atrial fibrillation after pulmonary vein isolation.

The case of a 65-year-old man with recurrent atrial fibrillation after undergoing segmental pulmonary vein isolation caused by the reconnection of previously isolated pulmonary veins is herein reported. Interestingly, frequent ectopic firings in the left superior pulmonary vein conducted to the left atrium, not through its ostium but through the supposed epicardial pathway at the region of the Marshall ligament, which had been absent during the first treatment session. The reisolation of the left superior pulmonary vein by radiofrequency application in the left atrial appendage thus successfully eliminated the occurrence of atrial fibrillation.

Prevalence, morphological and electrophysiological characteristics of confluent inferior pulmonary veins in patients with atrial fibrillation.

Background: Although the common trunk of left pulmonary veins (PVs) has been reported as a relatively popular anatomical variation of PVs, little is known about the coalescence of contralateral PVs. The present study was conducted to reveal the prevalence and electrophysiologic characteristics of the confluent inferior common PVs.

Methods And Results: Anatomical variation in the PV drainage to the left atrium (LA) was assessed using the multidetector computed tomography scan in 326 patients with atrial fibrillation (AF) who underwent the PV isolation procedure.

Hypoxemia in inferior pulmonary veins in supine position is dependent on obesity.

Rationale: Although arterial oxygen concentration decreases in obese subjects, the mechanism for this remains to be determined.

Objectives: The blood gas level in each pulmonary vein (PV) was measured in supine subjects with diverse body mass index (BMI) values, to determine whether there was a regional insufficiency in gas exchange depending on the subject's BMI.

Methods: Forty subjects with normal cardiopulmonary function who underwent a catheter ablation for atrial fibrillation were included.

Segmental pulmonary vein antrum isolation using the "large-size" lasso catheter in patients with atrial fibrillation.

Background: The limited efficacy and complications of segmental ostial pulmonary vein isolation (PVI) for treating atrial fibrillation (AF) have been discussed so, in the present study the feasibility and efficiency of performing segmental pulmonary vein (PV) antrum isolation to treat AF were assessed.

Methods And Results: A total of 187 patients with drug-refractory AF (paroxysmal 120, persistent 67) underwent segmental PVI guided by circumferential 20-electrode catheters (Lasso). Radiofrequency (RF) current was delivered either at the ostium using a regular Lasso (15-20 mm in diameter, 70 patients: Group 1) or at the antrum using a larger Lasso (25-30 mm in diameter, 117 patients: Group 2).

The effects of pulmonary vein isolation on the morphology of p waves: the contribution of pulmonary vein muscle excitation to the formation of p waves.

Background: Although the pulmonary veins have been demonstrated to play an important role in initiating and perpetuating atrial fibrillation, the role that cardiac muscle tissue in the pulmonary veins plays regarding the formation of P wave remains to be elucidated. We sought to clarify the contribution of pulmonary vein cardiac muscles to the formation of P waves by analyzing the P loops/waves in patients with atrial fibrillation.

Methods: The subjects in this study consisted of 21 patients (mean age, 57 +/- 10 years) with drug-refractory, paroxysmal atrial fibrillation who had undergone a segmental ostial isolation of all four pulmonary veins from the left atrium.

Behavior of atrial ectopic beats before and after pulmonary vein isolation in patients with atrial fibrillation: a reduction in the number and arrhythmogenicity of ectopic firings.

Background: No studies evaluating in a quantitative manner the effect of pulmonary vein (PV) isolation on the behavior of atrial premature beats have been reported.

Objectives: The purpose of this study was to reveal the behavior of atrial premature beats before and after PV isolation in patients with paroxysmal atrial fibrillation (AF).

Methods: In 108 patients free from AF following PV isolation, both the number of atrial premature beats and their coupling intervals before and following PV isolation were evaluated with periodic 24-hour ambulatory monitoring.