Objective : to evaluate the efficacy and safety of ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation. Methods : The study population consisted of 9 patients with 5 males and 4 fem...Objective : to evaluate the efficacy and safety of ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation. Methods : The study population consisted of 9 patients with 5 males and 4 females enrolled consecutively who had idiopathic paroxysmal atrial fibrillation(AF) . The ultrasound balloon was positioned through a special sheath to the orifice of the target vein by a transseptal procedure. The balloon was inflated with contrast-mixed saline (contrast: saline = 1:4) whose volume was decided by the diameter of the target pulmonary vein. The ablation energy was usually set up at 35 to 40 watts with temperature controlled at 60℃ . The duration of each ablation was about 120 seconds which was repeated not over 10 times. Results: The average duration of the total procedure was 132± 68 min for our patients. The average fluoroscopy time was 33 ±17 min. With a mean follow-up of 16 ±8 months after the procedure, AF was completely eliminated in 4 patients without antiarrhythmic drugs. The episodes of atrial fibrillation were eliminated in 2 patients with low dosage of oral amiodarone (0.1, once daily) which was ineffective before the procedure. The frequency of episodes was similar to that before the procedure in 3 patients. There were no complications such as hemopericardium, air embolism and stenosis of the pulmonary veins by angiography, related to the procedure. Conclusion : Ultrasound ablation of the pulmonary veins is a new approach to treat paroxysmal atrial fibrillation. Before we determined its value, we need to do more researches with bigger sample, randomization and comparison design.展开更多
Objective： To evaluate the incidence and clinical outcome of adenosine triphosphate（ATP） plus isoproterenol（ISP）-induced non-pulmonary vein（PV） foci before and after circumferential PV isolation（CPVI） during ...Objective： To evaluate the incidence and clinical outcome of adenosine triphosphate（ATP） plus isoproterenol（ISP）-induced non-pulmonary vein（PV） foci before and after circumferential PV isolation（CPVI） during index ablation in patients with paroxysmal atrial fibrillation（PAF）. Methods： In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation（AF） was provoked with ATP（20 mg） and ISP（20 μg/min） administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded. Results： Before ablation, AF mostly originating from PVs（PV vs. non-PV, 36/70 vs. 3/70; P〈0.01） was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked（post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016）. Patients with pre- and post-CPVI induced AF（n=49） were divided according to non-PV foci being induced（group N, n=17） or not（group P, n=32）. After mean（19.2±8.2） months follow-up, 88.2%（15/17） and 65.6%（21/32） of patients in groups N and P, respectively, were free from AF recurrence（P=0.088）. Conclusions： ATP＋ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.展开更多
文摘Objective : to evaluate the efficacy and safety of ultrasound ablation of pulmonary veins for treatment of paroxysmal atrial fibrillation. Methods : The study population consisted of 9 patients with 5 males and 4 females enrolled consecutively who had idiopathic paroxysmal atrial fibrillation(AF) . The ultrasound balloon was positioned through a special sheath to the orifice of the target vein by a transseptal procedure. The balloon was inflated with contrast-mixed saline (contrast: saline = 1:4) whose volume was decided by the diameter of the target pulmonary vein. The ablation energy was usually set up at 35 to 40 watts with temperature controlled at 60℃ . The duration of each ablation was about 120 seconds which was repeated not over 10 times. Results: The average duration of the total procedure was 132± 68 min for our patients. The average fluoroscopy time was 33 ±17 min. With a mean follow-up of 16 ±8 months after the procedure, AF was completely eliminated in 4 patients without antiarrhythmic drugs. The episodes of atrial fibrillation were eliminated in 2 patients with low dosage of oral amiodarone (0.1, once daily) which was ineffective before the procedure. The frequency of episodes was similar to that before the procedure in 3 patients. There were no complications such as hemopericardium, air embolism and stenosis of the pulmonary veins by angiography, related to the procedure. Conclusion : Ultrasound ablation of the pulmonary veins is a new approach to treat paroxysmal atrial fibrillation. Before we determined its value, we need to do more researches with bigger sample, randomization and comparison design.
文摘Objective： To evaluate the incidence and clinical outcome of adenosine triphosphate（ATP） plus isoproterenol（ISP）-induced non-pulmonary vein（PV） foci before and after circumferential PV isolation（CPVI） during index ablation in patients with paroxysmal atrial fibrillation（PAF）. Methods： In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation（AF） was provoked with ATP（20 mg） and ISP（20 μg/min） administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded. Results： Before ablation, AF mostly originating from PVs（PV vs. non-PV, 36/70 vs. 3/70; P〈0.01） was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked（post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016）. Patients with pre- and post-CPVI induced AF（n=49） were divided according to non-PV foci being induced（group N, n=17） or not（group P, n=32）. After mean（19.2±8.2） months follow-up, 88.2%（15/17） and 65.6%（21/32） of patients in groups N and P, respectively, were free from AF recurrence（P=0.088）. Conclusions： ATP＋ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.
