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Mechanism of recurrence after radiofrequency catheter ablation of atrial fibrillation guided by complex fractionated atrial electrograms.
Crawford, Thomas C; Wimmer, Alan; Dey, Sujoya; Chalfoun, Nagib; Wells, Darryl; Sarrazin, Jean-Francois; Kuhne, Michael; Frederick, Melissa; Jongnarangsin, Krit; Good, Eric; Chugh, Aman; Bogun, Frank; Pelosi, Frank; Morady, Fred; Oral, Hakan.
Afiliación
  • Crawford TC; Division of Cardiovascular Medicine, University of Michigan, SPC 5853, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5853, USA.
J Interv Card Electrophysiol ; 21(1): 27-33, 2008 Jan.
Article en En | MEDLINE | ID: mdl-18044014
BACKGROUND: A better understanding of the mechanisms of recurrent atrial fibrillation (AF) after radiofrequency ablation of complex, fractionated atrial electrograms (CFAEs) may be helpful for refining AF ablation strategies. METHODS AND RESULTS: Electrogram-guided ablation (EGA) was repeated in 30 consecutive patients (mean age = 59 +/- 8 years) for recurrent paroxysmal AF, 10 +/- 4 months after the first ablation. During the first procedure, CFAEs were targeted without isolating all pulmonary veins (PVs). During repeat ablation, all PVs and the superior vena cava (SVC) were mapped with a circular catheter and the left atrium was mapped for CFAEs. EGA was performed until AF was rendered noninducible or all identified CFAEs were eliminated. During repeat ablation, > or =1 PV tachycardia was found in 83 PVs in 29 of the 30 patients (97%). Among these 83 PVs, 63 (76%) had not been completely isolated previously. During repeat ablation, drivers originating in a PV or PV antrum were identified only after infusion of isoproterenol (20 mug/min) in 12 patients (40%). At 9 +/- 4 months of follow-up after the repeat ablation procedure, 21 of the 30 patients (70%) were free from recurrent AF and flutter without antiarrhythmic drugs. CONCLUSIONS: Recurrence of AF after EGA is usually due to PV tachycardias. Therefore, it may be preferable to systematically map and isolate all PVs during the first procedure. High-dose isoproterenol may be helpful to identify AF drivers.
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Ablación por Catéter / Mapeo del Potencial de Superficie Corporal / Atrios Cardíacos Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Interv Card Electrophysiol Asunto de la revista: CARDIOLOGIA Año: 2008 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Países Bajos
Buscar en Google
Añadir a Mi BVS
Imprimir
XML
PubMed Links

Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Ablación por Catéter / Mapeo del Potencial de Superficie Corporal / Atrios Cardíacos Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Interv Card Electrophysiol Asunto de la revista: CARDIOLOGIA Año: 2008 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Países Bajos