OBJECTIVES: The goal of this study was to describe the prevalence and ablation of coronary sinus(CS) arrhythmias after left atrial ablation for atrial fibrillation(AF). OBJECTIVES: The CS has been implicated in a vari...OBJECTIVES: The goal of this study was to describe the prevalence and ablation of coronary sinus(CS) arrhythmias after left atrial ablation for atrial fibrillation(AF). OBJECTIVES: The CS has been implicated in a variety of supraventricular arrhythmias. METHODS: Thirty-eight patients underwent mapping and ablation of atypical flutter that developed during(n=5) or after(n=33) ablation for AF. Also included were two patients with focal CS arrhythmias that occurred during an AF ablation procedure. A tachycardia was considered to be originating from the CS if the post-pacing interval in the CS matched the tachycardia cycle length and/or if it terminated during ablation in the CS. RESULTS: Among the 33 patients who developed atypical flutter late after AF ablation, 9(27%) were found to have a CS origin. Overall, 16 of the 40 patients in this study had a CS arrhythmia. The tachycardia was macro-re-entrant in 14 patients(88%) and focal in two patients. Radiofrequency ablation with an 8-mm-tip catheter was successful in 15 patients(94%) without complication. In eight patients(50%),< 45 W was required for successful ablation. Thirteen of the 15 patients(87%) with a successful ablation acutely remained arrhythmia free during 5±5 months of follow-up. CONCLUSIONS: The musculature of the CS serves as a critical component of the re-entry circuit in approximately 25%of patients with atypical flutter after ablation for AF. The CS may also generate focal atrial arrhythmias that may play a role in triggering and/or maintaining AF. Catheter ablation of these arrhythmias in the CS can be performed safely.展开更多
Background -Because the genesis of atrial fibrillation(AF)is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effect...Background -Because the genesis of atrial fibrillation(AF)is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set. Methods and Results -Catheter ablation was performed in 153 consecutive patients(mean age, 56±11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19%of patients and was still present in 10%at >12 weeks of follow-up. A repeat ablation procedure was performed in 18%of patients. During a mean follow-up of 11±4 months, 77%of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2%of procedures. Conclusions -A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal AF in ≈80%of patients.展开更多
Objectives: The purpose of this study was to identify ventricular tachycardia(VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus...Objectives: The purpose of this study was to identify ventricular tachycardia(VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus sites during sinus rhythm(SR). Background: Pace-mapping has been used in the scar border zone to identify the exit site of post-infarction VT. Methods: In 19 consecutive patients(18 men, mean age 66±9 years, mean ejection fraction 0.24±0.12) with post-infarction VT, a left ventricular voltage map was generated during SR. Pace-mapping was performed at sites with abnormal electrograms or isolated potentials. Radiofrequency ablation was performed at isthmus sites as defined by pace-mapping(perfect pace-map=12/12 matching electrocardiogram leads; good pace-map=10/12 to 11/12 matching electrocardiogram leads) and/or entrainment mapping. Results: A total of 81 VTs(mean cycle length 396±124 ms) were inducible. In 16 of the 19 patients, a total of 41 distinct isthmus areas of 41 distinct VTs were identified and successfully ablated. All but one displayed isolated potentials during SR. Furthermore, 22 of the 81 VTs(27%) for which no isthmus was identified became noninducible after ablation of a targeted VT. The 16 patients in whom ≥1 isthmus was identified and ablated were free of arrhythmic events during a mean follow-up of 10 months. Conclusions: During SR, excellent or good pace-maps at sites of isolated potentials within areas of scar identify areas of fixed block that are protected and part of the critical isthmus of post-infarction VT. Shared common pathways might explain why non-targeted VTs might become noninducible after ablation of other VTs.展开更多
文摘OBJECTIVES: The goal of this study was to describe the prevalence and ablation of coronary sinus(CS) arrhythmias after left atrial ablation for atrial fibrillation(AF). OBJECTIVES: The CS has been implicated in a variety of supraventricular arrhythmias. METHODS: Thirty-eight patients underwent mapping and ablation of atypical flutter that developed during(n=5) or after(n=33) ablation for AF. Also included were two patients with focal CS arrhythmias that occurred during an AF ablation procedure. A tachycardia was considered to be originating from the CS if the post-pacing interval in the CS matched the tachycardia cycle length and/or if it terminated during ablation in the CS. RESULTS: Among the 33 patients who developed atypical flutter late after AF ablation, 9(27%) were found to have a CS origin. Overall, 16 of the 40 patients in this study had a CS arrhythmia. The tachycardia was macro-re-entrant in 14 patients(88%) and focal in two patients. Radiofrequency ablation with an 8-mm-tip catheter was successful in 15 patients(94%) without complication. In eight patients(50%),< 45 W was required for successful ablation. Thirteen of the 15 patients(87%) with a successful ablation acutely remained arrhythmia free during 5±5 months of follow-up. CONCLUSIONS: The musculature of the CS serves as a critical component of the re-entry circuit in approximately 25%of patients with atypical flutter after ablation for AF. The CS may also generate focal atrial arrhythmias that may play a role in triggering and/or maintaining AF. Catheter ablation of these arrhythmias in the CS can be performed safely.
文摘Background -Because the genesis of atrial fibrillation(AF)is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set. Methods and Results -Catheter ablation was performed in 153 consecutive patients(mean age, 56±11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19%of patients and was still present in 10%at >12 weeks of follow-up. A repeat ablation procedure was performed in 18%of patients. During a mean follow-up of 11±4 months, 77%of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2%of procedures. Conclusions -A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal AF in ≈80%of patients.
文摘Objectives: The purpose of this study was to identify ventricular tachycardia(VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus sites during sinus rhythm(SR). Background: Pace-mapping has been used in the scar border zone to identify the exit site of post-infarction VT. Methods: In 19 consecutive patients(18 men, mean age 66±9 years, mean ejection fraction 0.24±0.12) with post-infarction VT, a left ventricular voltage map was generated during SR. Pace-mapping was performed at sites with abnormal electrograms or isolated potentials. Radiofrequency ablation was performed at isthmus sites as defined by pace-mapping(perfect pace-map=12/12 matching electrocardiogram leads; good pace-map=10/12 to 11/12 matching electrocardiogram leads) and/or entrainment mapping. Results: A total of 81 VTs(mean cycle length 396±124 ms) were inducible. In 16 of the 19 patients, a total of 41 distinct isthmus areas of 41 distinct VTs were identified and successfully ablated. All but one displayed isolated potentials during SR. Furthermore, 22 of the 81 VTs(27%) for which no isthmus was identified became noninducible after ablation of a targeted VT. The 16 patients in whom ≥1 isthmus was identified and ablated were free of arrhythmic events during a mean follow-up of 10 months. Conclusions: During SR, excellent or good pace-maps at sites of isolated potentials within areas of scar identify areas of fixed block that are protected and part of the critical isthmus of post-infarction VT. Shared common pathways might explain why non-targeted VTs might become noninducible after ablation of other VTs.
