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Catheter Ablation of Chronic Atrial Fibrillation Targeting the Reinitiating Triggers
Author(s) -
HAÏSSAGUERRE MICHEL,
JAÏS PIERRE,
SHAH DIPEN C.,
ARENTZ THOMAS,
KALUSCHE DIETRICH,
TAKAHASHI ATSUSHI,
GARRIGUE STÉPHANE,
HOCINI MÉLÈZE,
PENG JING TIAN,
CLÉMENTY JACQUES
Publication year - 2000
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2000.tb00727.x
Subject(s) - medicine , ablation , atrial fibrillation , cardiology , sinus rhythm , catheter ablation , coronary sinus , cardioversion , pulmonary vein , catheter , accessory pathway , stenosis , anesthesia , surgery
Trigger Ablation in Chronic AF. Introduction : We assessed the mode of reinitiation of atrial fibrillation (AF) after cardioversion and the efficacy of ablating these foci of reinitiation in patients with chronic AF. Methods and Results : Fifteen patients, 7 with structural heart disease, underwent mapping and catheter ablation of drug‐resistant AF documented to he persistent for 5 ± 4 months. In all patients, cardioversion was followed by documentation of P on T atrial ectopy and early recurrence, which allowed mapping of the reinitiating trigger or the source of ectopy. Radiofrequency (RF) ablation was performed at pulmonary vein (PV) ostia using a target temperature of 50°C and a power limit of 30 to 40 W, with the endpoint being interruption of all local muscle conduction. A total of 32 arrhythmogenic PVs and 2 atrial foci (left septum and left appendage) were identified: 1, 2, and 3 or 4 PVs in 5, 3, and 6 patients. RF applications at the ostial perimeter resulted in progressively increasing delay, followed by abolition of PV potentials in 8, but potentials persisted in 6. A single ablation session was performed in 7 patients and 8 underwent two or three sessions because of recurrence of AF; ablation was directed at the same source due to recovery of local PV potential or at a different PV. No PV stenosis was noted either acutely or at repeated follow‐up angiograms. Nine patients (60%) were in stable sinus rhythm without antiarrhythmic drugs at follow‐up of 11 ± 8 months. Anticoagulants were interrupted in 7 patients. Conclusion : PVs are the dominant triggers reinitiating chronic AF in this patient population. Elimination of PV potentials by ostial RF applications results in stable sinus rhythm in 60%. A larger group and longer follow‐up are needed to investigate further the role of trigger ablation in curative therapy for chronic AF.